Septic abortion is any type of abortion (spontaneous or induced) associated with infection of the uterus and its content during or after 20 weeks of gestation.
About 10% of abortions are septic and requires admission to the hospital. The majority of septic abortions are associated with incomplete abortion. In the majority of cases, the infection occurs following illegal induced abortion by an untrained practitioner but infection can occur even after spontaneous abortion.
Causes
Septic abortion is caused by microorganisms that are normally present in the vagina. The microorganisms are-
Anaerobic
- Anaerobic Streptococcus
- Clostridium welchii
- Tetanus bacilli
- Bacteroides group
Aerobic
- E. Coli
- Klebsiella
- Staphylococcus
- Hemolytic Streptococcus
- Pseudomonas
There is an increased association of infections in illegal induced abortion is due to
- Proper antiseptic and aseptic techniques are not followed during the procedure
- Incomplete evacuation by non-professionals in unhygienic settings
- Injury to the genital organs and adjacent organs during an evacuation
Symptoms
Women with septic abortion may have the following symptoms-
- High fever
- Chills suggestive of bloodstream spread of infection
- Severe abdominal pain
- Rising pulse rate
- Foul-smelling vaginal discharge
- Persistent vaginal bleeding
- Products of conception may or may not be expelled
- Foul purulent discharge from the uterus
- If the condition becomes severe, the signs of septic shock appear which include hypothermia (low body temperature), hypotension (low blood pressure), decreased urine output and respiratory distress.
Septic Abortion Grading
The cases of septic abortion are graded into
- Grade 1: The infection is localised in the uterus and is usually associated with spontaneous abortion.
- Grade 2: Infection spreads beyond the uterus to the pelvic structures like tubes, ovaries and pelvic peritoneum.
- Grade 3: Peritonitis (inflammation of the peritoneum) and development of septic shock or jaundice or acute renal failure. It is almost always associated with illegal induced abortion.
Diagnosis
Septic abortion is diagnosed by routine examination and special investigations.
Routine investigations may include
- Medical history
- Physical examination
- Blood for Hb estimation
- WBC- total and differential count
- Urinalysis including culture
- ABO and Rh grouping
- The cervical or high vaginal swab is taken before the internal examination to find out the dominant microorganisms
Special investigations may include
- Ultrasonography is done to detect the location and origin of the infection
- CT and MRI may also be used in some cases
- X-ray of the abdomen and pelvis
- Blood studies include culture, serum electrolytes and coagulation profile.
Complications
If a woman with septic abortion is not treated within the time it can lead to
- Haemorrhage
- Injury may occur to the uterus and also to the adjacent organs
- Peritonitis
- Septic shock
- Acute renal failure
- Thrombophlebitis (inflammation of the veins with thrombus formation)
- Chronic pelvic backache
- The tubal blockage leads to secondary infertility
- Ectopic pregnancy
- Emotional depression
- Painful sexual intercourse
All these lead to increased maternal death. About 20 to 25% of women die due to septic abortion if left untreated.
Treatment
First, hospitalization is very essential for all cases of septic abortion. High vaginal or cervical swabs were taken for culture and drug sensitivity.
Treatment of septic abortion involves control of the infection with antibiotic therapy and evacuation of the uterus.
Antibiotics may include penicillin, gentamicin, ceftriaxone, metronidazole and clindamycin. Antibiotic regimens can be modified according to the culture and sensitivity reports.
Evacuation of the uterus should be done within 24 hours following antibiotic therapy. Early emptying of the uterus not only minimises the risk of haemorrhage but also removes the products of infection. The procedure should be gentle to avoid injury to the uterus.
Prevention
Boost up family planning acceptance in order to limit unwanted pregnancies. Always take antiseptic and aseptic precautions either doing an internal examination or doing an operation in spontaneous abortion.
Enforcement of legalized abortion in practice and to stop the prevalence of unsafe abortions.
Illegal induction of abortion by an unauthorised person can be minimised by adequate education, motivation and extension of the facilities.
Conclusion
In the above post, we have discussed septic abortion. Any abortion associated with infection of the uterus and its content is considered septic. It usually results from illegal induced abortion by untrained practitioners. Fever, chills, foul vaginal discharge, severe abdominal pain, profuse bleeding are some symptoms, if not treated timely can lead to the death of the women. Septic abortion is usually treated with broad-spectrum antibiotics followed by evacuation of the uterus.
