Septic Abortion: A complication of home abortion

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Overview of septic abortion

Home abortion some say natural abortion is actually a criminal abortion or illegal abortion. As legal conflicts are not yet solved some countries give right of abortion to mother. But if we analyze the abortion facts we see this type of abortion is not only kills fetus but also have a deleterious effect on the mother’s health also. They may cause infection to uterus as well as peritoneum and blood resulting in morbidity and even death of mother. However a quick attention of a physician may solve the problem and save life.

Septic abortion definition

Septic abortion is an abortion which is complicated by infection of uterus and may spread infection to surrounding structures and to the systemic circulation.

Septic abortion causative organism

  • Streptococcus
  • Staphylococcus
  • Clostridium tetani
  • Bacteroids
  • Escherichia coli
  • Proteus
  • Klebsiella
  • Chlamydia and some natural flora also

Septic abortion symptoms

There is a history of variable period of amenorrhea. There is also a history of efforts to abort at home. However the history of home abortion is sometimes concealed.

Fever may be the first manifestation. Sometimes it takes time to develop fever. Fever is usually high and above 101 degree Fahrenheit. Chills and rigor may be associated.

Pelvic and lower abdominal severe pain is another early manifestations.

Malodorous vaginal discharge often copious vaginal discharge found. On general examination there may be tachycardia, fall of blood pressure, dry coated tongue, cold clammy skin, hurried respiration, blurring of vision, confusion, and no urine output for long period.

On per vaginal examination, cervical OS is closed, per vaginal bleeding seen, offensive smelling discharge coming out through vagina seen, sometimes cervical motion tenderness also elicited. Trauma to the cervix or upper vagina and sometimes roots of certain trees, leaves of trees, blisters in cervix and vagina may be found in case of criminal abortions causing septic abortion.

Clinical grading of septic abortion

Grade 1: When the infection is localized in the uterus it is termed as grade 1 septic abortion.

Grade 2: When the infection spreads beyond the uterus to the parametrium, tubes and ovaries or pelvic peritoneum it signifies grade 2 septic abortion.

Grade 3: When generalized peritonitis and/or endotoxic shock or jaundice or acute renal failure occurs it is termed as grade 3 septic abortion.

Grade 1 is the commonest and is usually associated with spontaneous abortion. Grade 3 is almost always associated with illegal induced abortion.

Complications of septic abortion

 Immediate complications of septic abortion

  • hemorrhage
  • injury
  • spread of infection leads to:

i.  generalized peritonitis

ii. endotoxic shock

iii. acute renal failure

iv. thrombophlebitis

All these lead to increased maternal deaths, the magnitude of which is to the extent of about 20-25% as per hospital statistics.

Remote complications of septic abortion

  • chronic debility
  • chronic pelvic pain and backache
  • dyspareunia
  • ectopic pregnancy
  • secondary infertility due to tubal blockage
  • Emotional depression.

Investigations for septic abortion

  • complete blood count
  • urinalysis
  • cervical or high vaginal swab and culture
  • endometrial cultures
  • blood cultures
  • coagulation profile e.g. bleeding time, clotting time, fibrin degradation product,
  • chest x-ray and abdominal x-ray for ruling out uterine perforation
  • Ultrasound for ruling out retained products of conception

Risk factors for septic abortion

  • Rupture of membrane suddenly due to trauma, insertion of abortificients or spontaneously due to any previous infection like urinary infection
  • Women who have sexually transmitted infection such as Chlamydia infection
  • Presence of intrauterine device (IUD) which was left in place during the pregnancy or forgotten intrauterine devices
  • Part of unborn child or placenta is left inside the uterus after a spontaneous or elective abortion
  • Criminal or illegal or unsafe abortion was made at home
  • Insertion of things that cause abortion like tools, chemicals, or soaps into the uterus for starting abortion.

Treatment of septic abortion

Treatment of septic abortion should be prompt and precise. At first we assure the patient is out of shock. For this we need to give her intravenous colloid solution preferably Hartmann solution or ringer lactate solution. Then we shall make arrangement for blood transfusion. Blood grouping, Rh typing, cross matching done at an emergency basis. And start blood transfusion as early as possible. All vital signs including pulse, temperature, blood pressure and urine output monitored frequently.

Anti tetanus immunoglobulin and anti gas gangrene serum are given immediately after checking sensitivity. If they have hyper sensitivity to these agents then they are given at slower rates. Tetanus toxoid also should be given.

Broad spectrum antibiotic consisting of ampicillin, gentamycin and metronidazole are given. Then we wait for culture and sensitivity report if these antibiotics are sensitive we continue them. But if not sensitive we change them to the sensitive ones.

After that we check for any bleeding and retained products of conception. If there is any product of conception which is retained we should do dilatation, evacuation and curettage immediately. This measure usually stops bleeding. If this fails to stop bleeding then go for other measures. Other measures include oxytocin injection, ergometrine injection, uterine message, per rectal prostaglandin, uterine packing and artery ligation.

If DIC is thought to be a cause of bleeding clotting factors are given. If clotting factor not found plasma may tried.

If there is severe peritonitis and uterine perforation we consider surgical toileting. If there is severe bleeding that can’t be controlled or severe infection causing endotoxic shock, general peritonitis, renal failure or jaundice hysterectomy should be done to prevent death.

Prevention of septic abortion

  • Boosting of family planning can give freedom from unwanted pregnancies and abortions.
  • Rigid enforcement of law to perform only legalized abortions only.
  • Antiseptic and aseptic precautions during internal examination or during procedures helps prevent spontaneous septic abortions.
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