SEPTIC ABORTION

Question 1

Management

Answer 1

• If os is closed, patient febrile, uterus is tender: suspect Septic Abortion –
  empiric IV Gentamycin & Clindamycin and consult OB

Question 2

Approach to the critical septic abortion

Answer 2

A / B - beware ards

C - 30 ml/kg bolus fluid, pressors PRN

Piperacillin-tazobactam 3.375 g intravenously every 6 hours

OR

Ampicillin 2,000 mg intravenous every 4 hours
Clindamycin 900 mg intravenously every 8 hours
Gentamicin 5 mg/kg intravenous every 24 hours

Consult OBGYN immediately

Question 3

H & P

Answer 3

fever, abdominal pain

hypotension

Peritonitis

+/- foul-smelling or purulent cervical discharge

pregnancy or recent pregnancy loss
Most commonly surgical abortion

Question 4

Critical DDx

Answer 4

Urinary tract infection/pyelonephritis
Appendicitis
Pelvic inflammatory disease
Postpartum endometritis

Question 5

Management

Answer 5

Piperacillin-tazobactam 4.5 g intravenously every 8 hours

Combination therapy (choose one of the following regimens):
Regimen 1
Ampicillin 2,000 mg intravenous every 4 hours
Clindamycin 900 mg intravenously every 8 hours
Gentamicin 5 mg/kg intravenous every 24 hours

Question 6

Management

Answer 6

Piperacillin-tazobactam 4.5 g intravenously every 8 hours

Combination therapy (choose one of the following regimens):
Regimen 1
Ampicillin 2,000 mg intravenous every 4 hours
Clindamycin 900 mg intravenously every 8 hours
Gentamicin 5 mg/kg intravenous every 24 hours