Septic Abortion

Question 0

Signs of septic abortion?

Answer 0

1. Uterine bleeding/spotted in the first trimester
2. Infection signs - Fever, WBC >10,500
3. Abdominal tenderness, cervical motion tenderness,
4. foul-smelling vaginal discharge

Question 1

Septic abortion?

Answer 1

Any type of abortion associated with uterine infection

Question 2

Organisms responsible for septic abortion?

Organisms less likely to be isolated?

Answer 2

Polymicrobial – anaerobic strep, Bacteriodies, E. coli, GBS

Clostridium perfringens, H influenza, Campylobacter

Question 3

Mechanism for infection in septic abortion?

Answer 3

Ascending infection from the vagina to cervix to endometrium to myometrium to parametrium to peritoneum

Question 4

Treatment of septic abortion?

Answer 4

1. Maintain blood pressure
2. Monitor blood pressure, O2 sat, urine output
3. Start antibiotics (gentamicin + clindamycin)
4. Curettage

Question 5

Antibiotic regimens for septic abortion?

Answer 5

1. Gentamicin + clindamycin
2. Cephalosporins OR penicillins + beta-lactamase inhibitors
3. Metronidazole + ampicillin + aminoglycoside

Question 6

Timing of curettage?

Answer 6

Four hours after antibiotics are begun

Question 7

Why observe urine output?

Answer 7

Oligoria is early sign of septic shock

Question 8

Patient with antibiotic treated septic abortion – CT scan shows pocket of air in muscle. Tx?

Answer 8

Necrotizing metritis – hysterectomy needed