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Septic Abortion


Aparna Sridhar

, MD, UCLA Health

Reviewed/Revised Oct 2023

Septic abortion is serious uterine infection during or shortly before or after a spontaneous or an induced abortion. Septic abortion is a gynecologic emergency.

Septic abortions usually result from use of nonsterile techniques for uterine evacuation after induced or spontaneous abortion. Septic abortions are much more common after induced abortion done by untrained clinicians (or the pregnant woman herself) and without adequate surgical equipment and sterile preparation, usually because there are legal, health care access, or personal barriers to receiving professional medical care.

Septic abortion could also result from an incomplete abortion that was secondarily infected due to an open cervical os.

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 of Septic Abortion

Symptoms and signs of septic abortion typically appear within 24 to 48 hours after abortion and are similar to those of pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. PID may be caused by sexually... read more (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 abortion typically causes severe pelvic or abdominal pain.

Septic shock Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more 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 of Septic Abortion

  • Vital signs and pelvic and abdominal examination

  • Blood cultures to guide antibiotic therapy

  • Complete blood count and other tests to evaluate patient status

  • Ultrasonography

Septic abortion is usually obvious clinically, typically based on finding symptoms and signs of severe infection in women who are or recently were pregnant. Ultrasonography should be done to check for retained products of conception as a possible cause. Uterine perforation should be suspected when women have unexplained severe abdominal pain and peritonitis. Ultrasonography is insensitive for detecting perforation.

When septic abortion is suspected, aerobic and anaerobic cultures of blood are done to help direct antibiotic therapy. Laboratory tests should include complete blood count (CBC) with differential, liver function tests, electrolyte levels, glucose, blood urea nitrogen (BUN), and creatinine. Prothrombin time (PT) and partial thromboplastin time (PTT) are done if liver test results are abnormal or if women have excessive bleeding. Products of conception should be sent to microbiology if possible. In patients with septicemia, evaluate for group A Streptococcus Streptococcal Infections Streptococci are gram-positive aerobic organisms that cause many disorders, including pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis. Symptoms vary with the organ... read more Streptococcal Infections and Clostridia Overview of Clostridial Infections Clostridia are spore-forming, gram-positive, anaerobic bacilli present widely in dust, soil, and vegetation and as normal flora in mammalian gastrointestinal tracts. Pathogenic species produce... read more .

Treatment of Septic Abortion

  • Intravenous empiric broad-spectrum antibiotic therapy (eg, clindamycin plus gentamicin with or without ampicillin)

  • Uterine evacuation

  • Sometimes pelvic or abdominal imaging

Treatment of septic abortion includes intravenous broad-spectrum antibiotic therapy, which should be initiated immediately. Choice of antibiotics should take into consideration that infections are polymicrobial, and treatment should cover gram-positive, gram-negative, and anaerobic bacteria. A typical empiric antibiotic regimen includes clindamycin 900 mg IV every 8 hours plus gentamicin 5 mg/kg IV once a day, with or without ampicillin 2 g IV every 4 hours. Alternatively, a combination of ampicillin, gentamicin, and metronidazole 500 mg IV every 8 hours can be used. Antibiotic regimen may be modified based on culture results.

In addition, uterine evacuation should be performed once the patient is stable. Patients with bleeding or suspected uterine perforation or organ damage may need further imaging (eg, MRI).

Key Points

  • Septic abortions usually result from use of nonsterile techniques for uterine evacuation after induced or spontaneous abortion; they are much more common after induced abortion procedures done by untrained clinicians using nonsterile techniques.

  • Septic abortion could also arise from an incomplete abortion that was secondarily infected due to an open cervical os.

  • Symptoms and signs (eg, chills, fever, vaginal discharge, peritonitis, vaginal bleeding) typically appear within 24 to 48 hours after an abortion. Patients could also present with severe unexplained pelvic or abdominal pain.

  • If septic abortion is suspected, immediately begin treatment with broad-spectrum antibiotics followed by prompt uterine evacuation; obtain blood cultures to guide antibiotic therapy.

Drugs Mentioned In This Article

Drug Name Select Trade
Aluvea , BP-50% Urea , BP-K50, Carmol, CEM-Urea, Cerovel, DermacinRx Urea, Epimide-50, Gord Urea, Gordons Urea, Hydro 35 , Hydro 40, Kerafoam, Kerafoam 42, Keralac, Keralac Nailstik, Keratol, Keratol Plus, Kerol, Kerol AD, Kerol ZX, Latrix, Mectalyte, Nutraplus, RE Urea 40, RE Urea 50 , Rea Lo, Remeven, RE-U40, RYNODERM , U40, U-Kera, Ultra Mide 25, Ultralytic-2, Umecta, Umecta Nail Film, URALISS, Uramaxin , Uramaxin GT, Urea, Ureacin-10, Ureacin-20, Urealac , Ureaphil, Uredeb, URE-K , Uremez-40, Ure-Na, Uresol, Utopic, Vanamide, Xurea, X-VIATE
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO
Garamycin, Genoptic, Genoptic SOP, Gentacidin, Gentafair, Gentak , Gentasol, Ocu-Mycin
Flagyl, Flagyl ER, Flagyl RTU, LIKMEZ, MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, NUVESSA, Nydamax, Rosadan, Rozex, Vandazole, Vitazol
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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