Abortion, Septic

Notes
  • This is a serious uterine infection that occurs during or shortly before or after an abortion.
  • It is common after unsafe abortion
Symptoms
  • Chills
  • Fever
  • Vaginal discharge
  • Often peritonitis
  • Vaginal bleeding
  • Lower back pain
  • Abdominal cramping /pain.
  • Cervix open / dilated
  • POCs)
Diagnosis
  • Pregnancy test
  • Ultrasound
  • Complete Blood Count
  • Blood typing and Rh testing
  • Serum hCG
  • Serum progesterone (rarely done)
  • Urinalysis and microscopy
  • Test for syphilis
  • Blood culture for patients in endotoxic shock
Differential
  • Benign hydatidiform mole
  • Blighted ovum
  • Cervical cancer
  • Cervical ectopic pregnancy
  • Dysfunctional uterine bleeding
  • Incompetent cervix
  • Tubal ectopic pregnancy
  • Adnexal Tumors
Prevention

None

Management
  • IV fluids, if required
  • To evacuate uterus by manual vacuum aspiration (MVA). This is done under paracervical block where 2.5ml of 1% Lignocaine is injected in areas at 2, 4, 8 and 10 o’clock positions avoiding intravascular injection. OR
  • Where the less invasive MVA is not available Sharp curettage (SC or D & C) is done.
  • IM Oxytocin 10IU STAT OR
  • IM Ergometrine 5mg STAT (to facilitate expulsion of products of conception, POCs). OR
  • Tabs Misoprostol 600mcg STAT or 400mcg sublingually.

##To treat or prevent infections and manage pain, administer;

For severe sepsis,

  • IV Crystalline penicillin 3 mega units QID PLUS IV Gentamycin 80mg TID PLUS  Metronidazole 500mg TID
  • For relieve of pain add an analgesic like : IM Diclofenac 75mg BD

For mild sepsis,            

  • Caps Doxycycline 100mg BD x 1/52 or Tabs amoxicillin/clavulonate 375mg TID x 1/52 PLUS
  • Tabs Metronidazole 400mg TID x 1/52 PLUS
  • Tabs Ibuprofen 400mg TID x 5/7
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