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.