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Septic Abortion

by Antonette T. Dulay, MD

Septic abortion is serious uterine infection during or shortly before or after an abortion.

Septic abortions usually result from induced abortions done by untrained practitioners using nonsterile techniques; they are much more common when induced abortion is illegal. Infection is less common after spontaneous abortion (see Spontaneous Abortion).

Typical causative organisms include Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, hemolytic streptococci, staphylococci, and some anaerobic organisms (eg, Clostridium perfringens). One or more organisms may be involved.

Symptoms and Signs

Symptoms and signs typically appear within 24 to 48 h after abortion and are similar to those of pelvic inflammatory disease (eg, chills, fever, vaginal discharge, often peritonitis) and often those of threatened or incomplete abortion (eg, vaginal bleeding, cervical dilation, passage of products of conception). Perforation of the uterus during the procedure typically causes severe abdominal pain.

Septic shock may result, causing hypothermia, hypotension, oliguria, and respiratory distress. Sepsis due to C. perfringens may result in thrombocytopenia, ecchymoses, and findings of intravascular hemolysis (eg, anuria, anemia, jaundice, hemoglobinuria, hemosiderinuria).

Diagnosis

  • Clinical evaluation

  • Cultures to guide antibiotic therapy

  • Ultrasonography

Septic abortion is usually obvious clinically, typically based on finding severe infection in women who are pregnant. Ultrasonography should be done to check for retained products of conception as a possible cause. Uterine perforation is most obvious during the procedure; it should be suspected when women have unexplained severe abdominal pain and peritonitis. Ultrasonography is insensitive for perforation.

When septic abortion is suspected, aerobic and anaerobic cultures of blood are done to help direct antibiotic therapy. Laboratory tests should include CBC with differential, liver function tests, electrolyte levels, glucose, BUN, and creatinine. PT and PTT are done if liver function test results are abnormal or if women have excessive bleeding.

Treatment

  • Intensive antibiotic therapy (eg, clindamycin plus gentamicin with or without ampicillin)

  • Uterine evacuation

Treatment is intensive antibiotic therapy plus uterine evacuation as soon as possible. A typical antibiotic regimen includes clindamycin 900 mg IV q 8 h plus gentamicin 5 mg/kg IV once/day, with or without ampicillin 2 g IV q 4 h. Alternatively, a combination of ampicillin, gentamicin, and metronidazole 500 mg IV q 8 h can be used.

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • GENOPTIC
  • FLAGYL
  • CLEOCIN
  • No US brand name

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