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.
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 typically appear within 24 to 48 hours 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 abortion 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).
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 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 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.
Treatment of septic abortion is intensive antibiotic therapy plus uterine evacuation as soon as possible. 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.
Septic abortions usually result from induced abortions done by untrained practitioners using nonsterile techniques; they are much more common where induced abortion is illegal.
Symptoms and signs (eg, chills, fever, vaginal discharge, peritonitis, vaginal bleeding) typically appear within 24 to 48 hours after an abortion.
If septic abortion is suspected, do blood cultures to guide antibiotic therapy.
Treat with broad-spectrum antibiotics plus prompt uterine evacuation.