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Septic abortion?

Any type of abortion associated with uterine infection


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


Organisms responsible for septic abortion?

Organisms less likely to be isolated?

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

Clostridium perfringens, H influenza, Campylobacter


Mechanism for infection in septic abortion?

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


Treatment of septic abortion?

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


Antibiotic regimens for septic abortion?

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


Timing of curettage?

Four hours after antibiotics are begun


Why observe urine output?

Oligoria is early sign of septic shock


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

Necrotizing metritis – hysterectomy needed