septic miscarriage
TRANSCRIPT
SEPTICMISCARRIAGE
DEFINITION
OAny abortion associated with
clinical evidences of infection of
uterus and its contents
Causes
Retained Product of Conception
• From incomplete spontaneous abortion or therapeutic abortion
Introduction of Infection into the Uterus
• Pathogens that caused septic abortion usually mixed and derived from vaginal flora and sexually transmitted bacteria
PathophysiologyBegins as endometritis and involves the endometrium and any retained products of conception.
not treated, the infection may spread further into the myometrium and parametrium.
Parametritis may progress into peritonitis.
Bacterimia and septic shock
EpidemiologyO Septic abortion remains a primary cause of maternal
mortality in the developing world, mostly as a result of illegal abortions
21.6 million women experience an unsafeabortion worldwide each year; 18.5 million ofthese occur in developing countries
47 000 women die from complications of unsafeabortion each year.
Deaths due to unsafe abortion remain close to13% of all maternal deaths.
Prevalance of Unsafe Abortion(WHO)
Signs and Symptoms
O Fever 38 C or more for at least 24 hrs
O Offensive or purulent vaginal discharge
O Lower abdominal pain, tenderness or
mass.
O Tachycardia of more than 100 per min.
O History of pregnancy
SEPTIC SHOCK
Tachypnea
Tachycardia
Hypotension
Hypothermia Oliguria
Sepsis Multi organ
failure
SEPTIC SHOCK
Low platelet
coagulopathy
DIVC
Investigations
O Blood
O Full blood count: infection, anemic
O Beta human chorionic gonadotropin
O Renal Profile: renal failure 2nd septic
shock
O Blood group and cross match
O ESR: suspected infection
O Blood culture and sensitivity: if patient is
febrile and systemic infection is suspected
O Swab : endocervical swab for culture and
sensitivity
O DIC: fibrinogen level, fibrin degradation
product and d-dimer
O Urinalysis
O TVS: TRO ectopic, retained POC, adnexal
mass, free fluid in cul-de-sac
Management
Medical
• Antibiotic
Surgical
• Dilation and curretage
• Posterior colpotomy
• Laparotomy
• Hysterectomy
Acute Management
O Administer intravenous fluids through a
large-bore angiocatheter
O unstable, administer oxygen and insert a
Foley catheter.
O Early antibiotic treatment may be guided
by Gram stain, but broad-spectrum
coverage is recommended.
Posterior Colpotomy
Indication
Pelvic Abscess
Abscess must be in midline
Abscess adhere to cul-de-sac peritoneum
cystic / fluctuant
Complications
False passage
Intra peritoneal rupture of abscess
bleeding
Laparotomy
Indications
Injury to uterus, or gut
Unresponsive peritonitis or
pelvic abscess
Presence of foreign body in abdomen
Hysterectomy
Indications
Irreparable injury to uterus bilateral
tuboovarian abscess
Spreading gas gangrene
infection in uterus