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Septic abortion?

Any type of abortion associated with uterine infection

1

Signs of septic abortion?

1. Uterine bleeding/spotted in the first trimester
2. Infection signs - Fever, WBC >10,500
3. Abdominal tenderness, cervical motion tenderness,
4. foul-smelling vaginal discharge

2

Organisms responsible for septic abortion?

Organisms less likely to be isolated?

Polymicrobial – anaerobic strep, Bacteriodies, E. coli, GBS

Clostridium perfringens, H influenza, Campylobacter

3

Mechanism for infection in septic abortion?

Ascending infection from the vagina to cervix to endometrium to myometrium to parametrium to peritoneum

4

Treatment of septic abortion?

1. Maintain blood pressure
2. Monitor blood pressure, O2 sat, urine output
3. Start antibiotics (gentamicin + clindamycin)
4. Curettage

5

Antibiotic regimens for septic abortion?

1. Gentamicin + clindamycin
2. Cephalosporins OR penicillins + beta-lactamase inhibitors
3. Metronidazole + ampicillin + aminoglycoside

6

Timing of curettage?

Four hours after antibiotics are begun

7

Why observe urine output?

Oligoria is early sign of septic shock

8

Patient with antibiotic treated septic abortion – CT scan shows pocket of air in muscle. Tx?

Necrotizing metritis – hysterectomy needed