Septic abortion

Any abortion associated with clinical evidence of infection of the uterus and its contents, is called septic abortion. The micro-organisms involved in the sepsis are usually those normally present in the vagina, such as anaerobic streptococci, tetanus bacillus, E.coli etc.

Clinical features -

• Pyrexia
• Pain
• A rising pulse rate - 100-120/ min or more
• Internal examination reveals offensive purulent vaginal discharge.

Clinical grading -
Grade 1 :- The infection is localized in the uterus.
Grade 2 :- The infection spreads beyond the uterus to the parametrium, tubes and ovaries or
                 pelvic peritoneum.
Grade 3 :- Generalized peritonitis and/or endotoxic shock or jaundice or acute renal failure.

Investigation -

• Ultrasonography (USG)
• Urine analysis including culture
• Cervical or high vaginal swab is taken for culture in aerobic and anaerobic media.

Complications -

Immediate :-

- Haemorrhage related to abortion process and also due to the the injury.

- Generalized peritonitis.

- Endotoxic shock.

- Acute renal failure.

- Thrombophlebitis.

Remote :-

- Dyspareunia.

- Ectopic pregnancy.

- Secondary infertility due to tubal blockage.

- Emotional depression.

Prevention - 

• To boost up family planning.
• To prevent unwanted pregnancy.
• To take antiseptic and aseptic precautions either during internal examination or during operation in spontaneous abortion.

Management -

General management :-

- Hospitalization is essential for all cases of septic abortion.

- To take high vaginal or cervical swab for culture and drug sensitivity.

- Vaginal examination is done to note the state of abortion process and extension of the infection.

- Investigation protocols are outlined.

- Principle of management is to control sepsis and remove the source of infection.

Treatment :- 

• Antibiotics, analgesics and sedatives drugs are mainly used.
• Evacuation of uterus - As abortion is often incomplete, evacuation should be performed at a convenient time within 24 hours.
• In grade II sepsis, posterior colpotomy is done when the infection is localized in the pouch of douglas, pelvic abscess is formed. Posterior colpotomy and drainage of the pus relieve the symptoms and improve the general condition of the patient.
• In grade III sepsis, the active surgery and laparotomy should be done.