Septic abortion

The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.

Background

Risk Factors

  • Non Sterile abortions
  • Advanced gestational age

Epidemiology

  • Huge cause of maternal mortality worldwide
  • Estimated 20 million unsafe abortions performed worldwide every year; 40% done on women ages 15-24[4]
  • WHO estimates 68,000 women die every year from unsafe abortions, with septic abortion being the #1 cause of death
  • Overall mortality: 20-50%
  • Mortality rare in US (1 in 100,000 abortions)

Clinical Features

Complications

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time

Vaginal Bleeding in Pregnancy (>20wks)

3rd Trimester/Postpartum Emergencies

Evaluation

  • Clinical diagnosis; patient may be reluctant to share information that she had an unsafe abortion
  • Labs: CBC, blood type with Rh status, CMP, serum beta-hcg level, UA, blood cultures
  • Gram stain and culture of any vaginal discharge
  • Check coagulation panel to rule out DIC
  • Pelvic exam – look for signs of trauma to cervix or vagina
  • Pelvic ultrasound – check for intrauterine material, abdominal free fluid, pelvic abscess
  • CT or MRI – may show uterine emphysema or intraperitoneal air if uterine perforation has occurred

Management

  • 2 large bore IVs; aggressive IV fluid resuscitation[6]
  • Assess for and control any vaginal bleeding
  • Broad-spectrum antibiotics – ampicillin 1-2 gm IV + gentamicin 1-2mg/kg IV + clindamycin 600-900mg IV or metronidazole 500mg IV
  • Tetanus vaccination
  • Early OB consult – Most will need evacuation of any remaining products of conception
  • Early surgery consult - Exploratory laparotomy if any pelvic free fluid or intra-abdominal air

Disposition

  • Admit

See Also

References

  1. Stubblefield, Phillip G., and David A. Grimes. "Septic Abortion." New England Journal of Medicine 331.5 (1994): 310-14.
  2. Finkielman, Javier et al. "The Clinical Course of Patients with Septic Abortion Admitted to an Intensive Care Unit." Intensive Care Medicine 30.6 (2004): 1097-102.
  3. Tintinalli, Judith E., and J. Stephan. Stapczynski. "Septic Abortion." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 682.
  4. Saultes, Teresa A., Devita, Diane., Heiner, Jason D. “The Back Alley Revisited: Sepsis after Attempted Self-Induced Abortion.” Western Journal of Emergency Medicine 10, 4 (2009) 278-280.
  5. Gaufberg, Salva V., MD, and Pamela L. Dyne, MD. "Abortion Complications."Abortion Complications. Medscape, 22 Oct. 2012.
  6. Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19.