Septic Abortion

Septic abortion is a spontaneous abortion made more difficult by intrauterine infection. Abortion is deemed septic when the following conditions exist:

1. For 24 hours, the temperature must rise to at least 100.4°F.
2. Vaginal discharge that is purulent or offensive
3. Lower abdomen pain and soreness are symptoms of a pelvic infection.

Mode of Infection

The following microorganisms are commonly found in the vagina and are involved in sepsis:

1. Anaerobic- anaerobic streptococci, clostridium welchi, and tetanus bacilli
2. Aerobic- Escherichia coli, klebsiella, staphylococcus, pseudomonas
3. Common mixed infection
   - Incomplete evacuation
   - Inadvertent injury to genital organs and adjacent structures, particularly gut
   - Proper antiseptic or asepsis is not used

Clinical Features

1. Fever
2. Tachycardia
3. Decreased blood pressure
4. Pallor, sweating
5. Abdominal distention, ileus
6. Flurried tongue
7. Variable period of amenorrhea
8. Foul-smelling from vaginal discharge
9. Fornices feel tender and boggy if a pelvic abscess is formed.

Clinical Grading

1. Grade -I
   The infection is restricted to the uterus (involves myometrium, endometrium)
2. Grade-II
   Beyond the uterus, the infection extended to the parametrium, tubes, and ovaries, as well as the pelvic peritoneum and pelvic structure.

Investigation

1. History taking
2. Physical examination
3. Complete blood count
4. Urinalysis
5. Blood urea, creatinine, and serum electrolytes
6. High vaginal swab
7. Pelvic ultrasonography to detect retained product of conception
8. Radiography of abdomen in case of peritonitis
9. Blood Hb%, grouping, and cross-matching
10. Blood culture when septicemia is suspected

Management

1. Hospitalized for all types of bacterial abortions
2. Maintain the patient's isolation and total bed rest.
3. In the event of a shock, the patient should receive an IV infusion, O2 inhalation, and blood transfusion.
4. A vaginal examination should be performed to rule out the possibility of an abortion and the spread of infection.
5. Maintain input and outflow charting while catheterizing the patient with an aseptic approach.
6. Encourage the patient to undergo any necessary tests, such as urine culture, blood culture, vaginal swab, hemoglobin, blood grouping, and cross-matching.
7. To treat pain, an injection of pethidine 100mg IM may be used.
8. Monitor and record the general vital signs.
9. Advice to maintain the perineal and vaginal areas, as well as to change them periodically
10. Educate people on the importance of eating a well-balanced, nutritious diet.
11. Encourage people to drink plenty of water.
12. Evacuation of the uterus as quickly as possible IV fluid and blood transfusion as needed by the patient
13. Antibiotics, analgesics, and antitetanus medication as prescribed by a doctor.

References

• Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
• SlideShare. https://www.slideshare.net/crisbertc/types-of-abortion
• Prezi. 17 February 2011. https://prezi.com/7avru5nzs1en/types-of-abortion-management-nurses-perspective/
• NCBI. 22 June 1930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381898/?page=3
• NYTimes. 14. March 2017. http://www.nytimes.com/health/guides/disease/abortion-threatened/overview.html