| ID | 325 |
|---|---|
| Name | SEPTIC ABORTION |
| Cause | Use of nonsterile techniques for uterine evacuation after induced or spontaneous abortion |
| Signs Symptoms | Chills, fever, vaginal discharge, a rapid heart rate, and often vaginal bleeding. The cervix may dilate, and a miscarriage, if one has not already occurred, is possible |
| Diagnosis | see under symptoms |
| Investigations | Investigations: 1. Blood for Hb%, TC, DC, ESR & C/S- both erobic and anerobic. 2. Urine for R/E and C/S. 3. High vaginal & cervical swab for C/S and gram staining. 4. If anuria present- blood urea & serum electro-lytes to be estimated. |
| Management | Intensive broad-spectrum 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 |
| Introduction | Abortion complicated with superadded infection during or soon after abortion is known as septic abortion. It most commonly occurs in induced (criminal) abortion and incomplete abortion. Infection caused by commonly- E coli, Streptococci, Staphylococci, Cl. welchi, Pneumococci, Gonococci & Cl. tetani also may cause the infection. |
| History | |
| Etiology | see under caiuses |
| Clinical Features | Clinical features: Symptoms: 1. History of amenorrhoea and induction . 2. Hectic rise of temparature (101-104°F), rigor, tachycardia with malaise, anorexia, vomiting, headache. 3. Lower abdominal pain. Signs: 1. Fever, pulse rate increased. 2. P/A exam- lower abdomen tender. 3. P/V exam- foul smelling discharge may blood stained. Uterus bulky soft, pus may collect in pouch of douglus, os open. |
| Preventions | Access to effective and acceptable contraception; access to safe, legal abortion in case of contraceptive failure; and appropriate medical management of abortion |
| Treatment | Treatment: Medical treatment: 1. Hospitalization & isolation 2. Blood transfusion- to improve body resistance & correction of anemia. 3. Broad spectrum antibiotic: after collecting swab for C/S-Inj. Amoxicillin or cephalosporin (as per C/S report) plus Inj. Gentamicin 80mg 8-hourly plus Metronidazole 500mg 8-hourly All are for 7-10 days. 4. In case of endotoxic shock- a. i.v fluid as required b. correction of acidosis c. adequate oxygenation d. broad spectrum antibiotic in large dose. e. high dose of steroid- hydro cortisone 300-500mg i.v 8-hourly, then taper the dose gradually. Surgical treatment: 1. Evacuation of the uterus- it should be done after control of infection under G/A & antibiotic coverage. 2. If os is closed- D&C should be done after 6-7 days. 3. Posterior colpotomy- incase of pelvic abscess. 4. If medical treatment fails & the patient is an older one (i.e family complete) hysterectomy is preferable. |
| Complications | Complications: 1. Endotoxic shock 2. Anuria, acute renal failure 3. Generalised peritonitis 4. Thrombophlebitis |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team