SEPTICMISCARRIAGE

DEFINITION

OAny abortion associated with

clinical evidences of infection of

uterus and its contents

Causes

Retained Product of Conception

• From incomplete spontaneous abortion or therapeutic abortion

Introduction of Infection into the Uterus

• Pathogens that caused septic abortion usually mixed and derived from vaginal flora and sexually transmitted bacteria

PathophysiologyBegins as endometritis and involves the endometrium and any retained products of conception.

not treated, the infection may spread further into the myometrium and parametrium.

Parametritis may progress into peritonitis.

Bacterimia and septic shock

EpidemiologyO Septic abortion remains a primary cause of maternal

mortality in the developing world, mostly as a result of illegal abortions

21.6 million women experience an unsafeabortion worldwide each year; 18.5 million ofthese occur in developing countries

47 000 women die from complications of unsafeabortion each year.

Deaths due to unsafe abortion remain close to13% of all maternal deaths.

Prevalance of Unsafe Abortion(WHO)

Signs and Symptoms

O Fever 38 C or more for at least 24 hrs

O Offensive or purulent vaginal discharge

O Lower abdominal pain, tenderness or

mass.

O Tachycardia of more than 100 per min.

O History of pregnancy

SEPTIC SHOCK

Tachypnea

Tachycardia

Hypotension

Hypothermia Oliguria

Sepsis Multi organ

failure

SEPTIC SHOCK

Low platelet

coagulopathy

DIVC

Investigations

O Blood

O Full blood count: infection, anemic

O Beta human chorionic gonadotropin

O Renal Profile: renal failure 2nd septic

shock

O Blood group and cross match

O ESR: suspected infection

O Blood culture and sensitivity: if patient is

febrile and systemic infection is suspected

O Swab : endocervical swab for culture and

sensitivity

O DIC: fibrinogen level, fibrin degradation

product and d-dimer

O Urinalysis

O TVS: TRO ectopic, retained POC, adnexal

mass, free fluid in cul-de-sac

Management

Medical

• Antibiotic

Surgical

• Dilation and curretage

• Posterior colpotomy

• Laparotomy

• Hysterectomy

Acute Management

O Administer intravenous fluids through a

large-bore angiocatheter

O unstable, administer oxygen and insert a

Foley catheter.

O Early antibiotic treatment may be guided

by Gram stain, but broad-spectrum

coverage is recommended.

Posterior Colpotomy

Indication

Pelvic Abscess

Abscess must be in midline

Abscess adhere to cul-de-sac peritoneum

cystic / fluctuant

Complications

False passage

Intra peritoneal rupture of abscess

bleeding

Laparotomy

Indications

Injury to uterus, or gut

Unresponsive peritonitis or

pelvic abscess

Presence of foreign body in abdomen

Hysterectomy

Indications

Irreparable injury to uterus bilateral

tuboovarian abscess

Spreading gas gangrene

infection in uterus