Septic and Missed Abortion

It commonly arises as a complication of induced or incomplete abortion.

• Escherichia coli.
• Non-hemolytic streptococci.
• Staphylococcus aureus.
• Streptococcus pyogenes.
• Streptococcus pneumoniae.

• History of amenorrhea and incomplete abortion.
• Pyrexia (fever).
• Tender uterus on palpation.
• Rapid pulse.
• Patient’s awareness of interference with the pregnancy.
• Headache.
• General malaise.
• Severe lower abdominal pain.
• Profuse offensive brownish discharge from the vagina.
• Mental confusion and endotoxic shock.

In the Maternity Center:

• Arrange transport to the hospital.
• While waiting for transport, keep the patient isolated.
• Examine the patient and record all particulars.
• Send the patient to the hospital with a written note.

In the Hospital:

• Admit the mother to a gynaecological ward in isolation.
• Take a detailed history from the patient.
• Nurse the patient in a sitting-up position to aid drainage of liquor or pus from the uterus.
• Perform a general examination to rule out anaemia, shock, etc.
• Monitor vital observations.
• Inform the doctor.
• Conduct necessary investigations, e.g., blood for HB, grouping, and cross-match, high vaginal swab for culture and sensitivity.
• CBC indicates elevation of white blood cell count.
• Vaginal swab may be recommended to identify the causative bacteria
• Administer intravenous fluids for rehydration and electrolyte replacement.
• Conduct blood transfusion if the patient is anaemic.
• Provide a highly nutritious diet.
• Administer broad-spectrum antibiotics based on laboratory results.
• Avoid urine retention and oliguria indicating tubular necrosis.
• Perform evacuation after the course of antibiotics.
• Medical treatment includes injection penicillin, gentamycin, and hydrocortisone to counteract shock.
• Treatment should start with IV antibiotics and then switch to oral antibiotics. Amoxicillin 500mg 8 hourly for 7 days plus metronidazole 400mg 8 hourly for 7 days.
• Give IV fluids and tetanus toxoid.

• Septicemia : Septic abortion can lead to the development of septicemia, a condition characterized by the systemic spread of infection, resulting in high fever, rapid heart rate, and altered mental status.
• Renal Failure: In severe cases of septic abortion, the systemic infection can lead to acute renal failure, a condition marked by the loss of kidney function, resulting in decreased urine output, fluid retention, and electrolyte imbalances.
• Uterine Perforation : Instrumentation or medical procedures associated with septic abortion can lead to uterine perforation, a serious complication that may result in internal bleeding, infection.
• Pelvic Thrombophlebitis : Septic abortion can increase the risk of developing pelvic thrombophlebitis, a condition characterized by the formation of blood clots in the pelvic veins, leading to pain, swelling, and the risk of pulmonary embolism.
• Anaemia : Prolonged or heavy bleeding associated with septic abortion can lead to anaemia, a condition marked by a low red blood cell count, resulting in fatigue, weakness, and shortness of breath.
• Disseminated Intravascular Coagulation (DIC): In severe cases of septic abortion, the body’s response to infection can lead to disseminated intravascular coagulation, a condition characterized by abnormal blood clotting and bleeding.

Missed abortion also refers to fetal death without expulsion of products of conception.

Death of the embryo usually occurs before 8 weeks gestation.

Cessation of symptoms of pregnancy usually prompts the mother to seek medical attention from a health facility. Symptoms include vaginal bleeding, abdominal pain, brown vaginal discharge and the cervix is usually closed.

• History of amenorrhea.
• Symptoms of threatened abortion occur and cease.
• Absence of usual signs of pregnancy progress.
• Reduction in breast size.
• Fundus loss for dates due to fetal non-growth.
• Complete separation of products of conception from uterine walls without expulsion.
• Uterus ceases to enlarge, and the cervix remains tightly closed.
• After several weeks, brown discharge precedes bleeding, lower abdominal pain, and expulsion of a reddish-brown mass.

In the Maternity Center:

• Prepare transport to the hospital.
• While waiting, obtain the patient’s history and conduct an examination.
• Send the patient to the hospital with a written note.

In the Hospital:

• Admit the patient to a gynaecological ward.
• If spontaneous abortion doesn’t occur, intravenous infusion of prostaglandins or oxytocin may be given.
• If the mole is not expelled, surgical emptying of the uterus using a suction curette is performed after cervix dilation.
• Administer analgesics for pain relief.
• Monitor vital observations: temperature, pulse, respiration, and blood pressure.

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