Septic abortion is serious uterine infection during or shortly before or after a spontaneous or an induced abortion. Septic abortion is a gynecologic emergency.
Septic abortions usually result from use of nonsterile techniques for uterine evacuation after induced or spontaneous abortion. Septic abortions are much more common after induced abortion done by untrained clinicians (or the pregnant woman herself) and without adequate surgical equipment and sterile preparation, usually because there are legal, health care access, or personal barriers to receiving professional medical care.
Septic abortion could also result from an incomplete abortion that was secondarily infected due to an open cervical os.
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
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 pelvic or 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).
Diagnosis of Septic Abortion
Vital signs and pelvic and abdominal examination
Blood cultures to guide antibiotic therapy
Complete blood count and other tests to evaluate patient status
Ultrasonography
Septic abortion is usually obvious clinically, typically based on finding symptoms and signs of severe infection in women who are or recently were 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 detecting perforation.
Treatment of Septic Abortion
Uterine evacuation
Sometimes pelvic or abdominal imaging
In addition, uterine evacuation should be performed once the patient is stable. Patients with bleeding or suspected uterine perforation or organ damage may need further imaging (eg, MRI).
Key Points
Septic abortions usually result from use of nonsterile techniques for uterine evacuation after induced or spontaneous abortion; they are much more common after induced abortion procedures done by untrained clinicians using nonsterile techniques.
Septic abortion could also arise from an incomplete abortion that was secondarily infected due to an open cervical os.
Symptoms and signs (eg, chills, fever, vaginal discharge, peritonitis, vaginal bleeding) typically appear within 24 to 48 hours after an abortion. Patients could also present with severe unexplained pelvic or abdominal pain.
If septic abortion is suspected, immediately begin treatment with broad-spectrum antibiotics followed by prompt uterine evacuation; obtain blood cultures to guide antibiotic therapy.
