Septic abortion

A septic abortion "is an infection of the placenta and fetus (products of conception) of a previable pregnancy. Infection is centered in the placenta and there is risk of spreading to the uterus, causing pelvic infection or becoming systemic to cause septicemia and potential damage of distant vital organs."^[1]

Signs and symptoms

In a woman with septic abortion, signs and symptoms that are related to the infection are mainly:

• High fever, usually above 101 °F / 38°C
• Chills
• Severe abdominal pain and/or cramping /or strong perineal pressure
• Beginning miscarriage symptoms (heavy bleeding and or cramping) that suddenly stops and does not resume
• Prolonged or heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Backache or heavy back pressure

A cold or urinary tract infection may mimic many of the symptoms.

As the condition becomes more serious, signs of septic shock may appear, including:

• Low blood pressure (hypotension)
• Low body temperature (hypothermia)
• Little or no urine output (oliguria)
• Respiratory distress (dyspnea and labored breathing)

Septic shock may lead to kidney failure, bleeding diathesis, and disseminated intravascular coagulation (DIC). Intestinal organs may also become infected, potentially causing scar tissue with chronic pain, intestinal blockage, and infertility.

If the septic abortion is not treated quickly and effectively, the woman may die.

Causes

A septic abortion can occur when bacteria enters the uterus. The bacteria may also belong to the vaginal flora. Also, sexually transmitted infections (STI) such as chlamydia may cause septic abortion.

Risk factors

The risk of a septic abortion is increased by mainly the following factors:

• The fetal membranes surrounding the unborn child have ruptured, sometimes without being detected
• The woman has a sexually transmitted infection such as chlamydia
• An intrauterine device (IUD) was left in place during the pregnancy
• Tissue from the unborn child or placenta is left inside the uterus after a miscarriage or elective abortion procedure
• Unsafe abortion was made to end the pregnancy
• Insertion of tools, chemicals, or soaps into the uterus

Prevention

Better birth control and legal abortion (to prevent unsafe abortions) have dramatically reduced the number of septic abortions. To decrease the risk further, a woman should be tested for common sexually transmitted infections in the first trimester of her pregnancy. If a woman thinks she might be miscarrying or has miscarried, she should call her healthcare provider immediately.

Treatment

The woman should have intravenous fluids to maintain blood pressure and urine output (Oliguria or hypouresis both names from roots meaning "not enough urine" is the low output of urine). Broad-spectrum intravenous antibiotics should be given until the fever is gone.

A dilatation and curettage (D&C) or misoprostol may be needed to clean the uterus of any residual tissue. Rh negative blood should be given to the patient in addition to an injection of Rh immune globulin, unless the father is also known to be Rh negative. In cases so severe that abscesses have formed in the ovaries and tubes, it may be necessary to remove the uterus by hysterectomy, and possibly other infected organs as well.

After successful treatment of a septic abortion, a woman may be tired for several weeks. In case of substantial bleeding, iron supplementation may be helpful. Sexual intercourse or the use of tampons should be avoided until recommended by the healthcare provider.

References

^[1]

1. ↑ Eschenbach, D. (2015). "Treating spontaneous and induced septic abortions". Obstetrics and Gynecology. 125 (5). doi:10.1097/AOG.0000000000000795.