Management of Septic Abortion

Initial Steps at the Maternity Center:

• Arrange Immediate Hospital Transfer: The first priority is to organize safe transportation to a hospital equipped to manage septic abortion.

• Patient Isolation (While Awaiting Transfer): To minimize infection risk to others, keep the patient separate from other individuals while transport is being arranged.

• Preliminary Patient Assessment and Documentation: Conduct a brief examination, noting down essential details about the patient’s condition for handover at the hospital.

• Written Referral Note: Ensure the patient is sent to the hospital accompanied by a detailed referral note outlining the situation and initial observations.

Hospital Management:

1. Hospital Admission and Isolation: Upon arrival, admit the patient to a gynecology ward, ideally in an isolation setting to prevent cross-infection.

2. Detailed Patient History: Obtain a thorough medical history from the patient, focusing on the abortion event and related symptoms.

3. Positioning for Drainage: Position the patient in a semi-sitting ( Fowler’s ) position. This posture helps facilitate the natural drainage of infected fluids or pus from the uterus.

4. Comprehensive Physical Examination: Perform a complete physical exam to identify related issues such as anemia or shock that may require immediate attention.

5. Continuous Vital Signs Monitoring: Regularly monitor and record vital signs (temperature, pulse, blood pressure, respiration) to track the patient’s condition closely.

6. Physician Consultation: Immediately inform the attending physician about the patient’s condition for prompt medical direction.

7. Essential Diagnostic Investigations: Order necessary lab tests, including:

   • Blood Tests: Complete blood count (CBC), hemoglobin (HB) level, blood grouping and cross-matching for potential transfusion.

   • High Vaginal Swab: Collect a sample for culture and sensitivity testing to identify the specific bacteria causing the infection and guide antibiotic selection.

8. White Blood Cell Count Evaluation: A CBC is expected to show an elevated white blood cell count, indicating infection.

9. Microbial Identification: A vaginal swab culture is crucial to pinpoint the exact bacterial species responsible for the septic abortion, guiding targeted antibiotic therapy.

10. Intravenous Fluid Resuscitation: Start intravenous fluids to correct dehydration and restore electrolyte balance, which are often disrupted by infection and sepsis.

11. Blood Transfusion (If Needed): Administer a blood transfusion if the patient is found to be anemic, often due to blood loss or the effects of infection.

12. Nutritional Support: Provide a diet rich in nutrients to support the body’s recovery and immune response.

13. Broad-Spectrum Antibiotic Therapy: Initiate treatment with broad-spectrum intravenous antibiotics promptly, even before culture results are available, to cover a wide range of potential pathogens. Antibiotic choice will be refined based on culture and sensitivity results when available.

14. Renal Function Monitoring: Closely monitor urine output and renal function. Reduced urine output (oliguria) can be an early sign of acute tubular necrosis, a serious kidney complication.

15. Uterine Evacuation (Post-Antibiotics): Perform uterine evacuation (surgical removal of retained tissue) only after a course of antibiotics has been administered and the patient is stable. This is to reduce the risk of spreading infection during the procedure.

16. Pharmacological Adjuncts: Medical treatment might include medications like injectable penicillin, gentamycin (antibiotics), and hydrocortisone (corticosteroid) to manage severe infection and counteract shock if present.

17. Antibiotic Regimen: Treatment typically begins with intravenous antibiotics for rapid action, transitioning to oral antibiotics as the patient improves. A common oral regimen could be Amoxicillin 500mg every 8 hours for 7 days combined with Metronidazole 400mg every 8 hours for 7 days.

18. Supportive Care: Administer intravenous fluids to maintain hydration and give tetanus toxoid injection for tetanus prophylaxis.

Complications of Septic Abortion

• Septicemia (Blood Poisoning): Septic abortion can progress to septicemia, a life-threatening condition where the infection spreads throughout the bloodstream, causing systemic illness characterized by high fever, rapid heartbeat, and altered mental state.

• Acute Renal Failure (Kidney Failure): Severe septic abortion can lead to acute renal failure. This serious complication involves a sudden loss of kidney function, resulting in decreased urine production, fluid overload, and imbalances in electrolytes.

• Uterine Perforation: Procedures related to managing septic abortion, especially surgical interventions, carry a risk of uterine perforation. This is a serious injury where the uterus is punctured, potentially leading to internal hemorrhage, infection spread, and damage to surrounding organs.

• Pelvic Thrombophlebitis: Septic abortion increases the likelihood of pelvic thrombophlebitis, which is the formation of blood clots within the veins of the pelvis. This condition can cause pelvic pain, swelling, and poses a risk of pulmonary embolism if a clot travels to the lungs.

• Anemia: Prolonged or excessive bleeding, a common feature of septic abortion, can result in anemia. This is a condition of reduced red blood cells, leading to symptoms like fatigue, weakness, and shortness of breath.

• Disseminated Intravascular Coagulation (DIC): In severe septic abortion cases, a dangerous condition called DIC can develop. DIC disrupts normal blood clotting processes, leading to paradoxical clotting and bleeding throughout the body, which can be life-threatening.