Septic abortion

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)

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.