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abortion, septic

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Female reproductive organs

A septic abortion occurs when an infection develops inside a pregnant woman's uterus. If not treated, it can spread well beyond the uterus and even to the bloodstream.

What is going on in the body? 
Occasionally, bacteria that live in a woman's vagina, organisms from an untreated sexually transmitted disease (STD), or unclean tools used during a "back yard" abortion pass through the cervix and into the uterus. This is usually prevented by a plug of mucous in the cervix and the membranes surrounding the foetus, which help block infection. The infection can spread through the foetal tissue to the lining of the uterus. It may go into the muscles of the uterus or beyond that to other nearby organs. If the infection reaches the bloodstream, it is called septicaemia. The mother's immune system sends out white blood cells to combat the infection, which may raise her body temperature causing a fever to fight the infection.

What are the signs and symptoms of the condition? 
Signs and symptoms of a septic abortion include:
  • backache
  • prolonged or heavy bleeding
  • foul smelling vaginal discharge
  • pelvic discomfort
  • chills
  • a high fever (usually above 38 degrees Celsius)
  • severe abdominal pain or cramping
As the condition becomes more serious, signs of shock may appear. These include:
  • low blood pressure
  • low body temperature
  • little or no urine output
  • trouble breathing
What are the causes and risks of the condition? 
A septic abortion usually occurs when:
  • the membranes surrounding the foetus have ruptured, sometimes without being detected
  • an intra-uterine device (IUD) was left in place during the pregnancy
  • attempts were made to end the pregnancy, often illegally, by inserting tools or injecting chemicals or soaps into the uterus
What can be done to prevent the condition? 
Better birth control and legal abortion have dramatically reduced the number of septic abortions. To cut the risk further, a woman should be tested for common STDs in the first trimester. If a woman thinks she might be miscarrying or has miscarried, she should call her doctor right away. Signs of a problem include:
  • vaginal bleeding
  • cramping
  • passage of foetal tissue or clots from the vagina
  • fever
It may be too late to save the pregnancy, but good follow-up care can prevent infection.

How is the condition diagnosed? 
This condition is diagnosed when a woman has a temperature of at least 38 degrees Celsius, plus other signs and symptoms of septic abortion. Other reasons for the fever, such as a cold or bladder infection, must be ruled out. A physical examination and pelvic examination will be done. The findings may include:
  • abdominal tenderness.
  • signs of infection of the membrane sac in the abdomen called peritonitis. Peritonitis is an inflammation or infection of the lining of the abdomen and pelvis.
  • an open cervix, possibly with pus-filled discharge draining from it.
  • tenderness in the ovaries or uterus.
Other diagnostic tests may be done. These include:
  • a blood test. This may show a high white blood cell count (WBC).
  • an ultrasound. This may show foetal tissue, a dead foetus or an empty sac in the uterus.
  • additional tests done to detect bacteria in the uterus or bloodstream.
What are the long-term effects of the condition? 
A woman who is critically ill may show signs of bacterial shock and cardiac collapse, such as:
  • little or no urine
  • low blood pressure
  • fast heart rate
  • mental confusion
  • clammy skin
Shock may lead to kidney failure, general bleeding and clotting problems that can be hard to stop. Sometimes it ends in death.

If the infection spreads to the abdomen, intestinal organs may also become infected. That can cause scar tissue or adhesions leading to chronic pain, intestinal blockage and infertility.

What are the risks to others? 
The risk to the foetus is death.

What are the treatments for the condition? 
Immediate and aggressive treatment in a hospital is necessary to avoid serious complications. The woman should have intravenous (IV) fluids to maintain blood pressure and urine output. IV antibiotics will be given to cover a range of bacteria until the fever is gone. A dilatation and curettage (D&C) may be needed to clean out the uterus if foetal tissue has remained inside it. In cases so severe that abscesses have formed in the ovaries and tubes, it may be necessary to remove the uterus and the infected organs.

What are the side effects of the treatments? 
Side effects of the treatment vary depending on the antibiotic. They may include: What happens after treatment for the condition? 
Following a septic abortion, a woman may be tired for several weeks. Taking vitamins with iron once a day will help. She should not have intercourse or use tampons for at least 2 weeks until she follows up with her doctor. If a pregnancy is desired, a couple should wait 3 months after treatment is successfully completed to try to conceive. If they are not successful within a year, a test may done to see if the fallopian tubes were damaged by the infection. A woman should be alert to signs of depression. If she does become depressed, counselling or antidepressant drugs can help.

How is the condition monitored? 
After treatment, a woman is counselled to call her doctor if she develops a fever, abdominal pain, vaginal bleeding, or a foul smelling discharge.

Author: Eva Martin, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 25/04/2005
Potential conflict of interest information for reviewers available on request

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