Typical causative organisms include Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, hemolytic streptococci, staphylococci, and some anaerobic organisms (eg, Clostridium perfringens). One or more organisms may be involved.
The bacteria involved in septic abortion are usually polymicrobial, particularly anaerobes that have ascended from the lower genital tract.
do blood cultures to guide antibiotic therapy.
The woman should have intravenous fluids to maintain blood pressure and urine output (Oliguria or hypouresis both names from roots meaning "not enough urine" is the low output of urine).
A dilatation and curettage (D&C) or misoprostol may be needed to clean the uterus of any residual tissue. Rh negative blood should be given to the patient in addition to an injection of Rh immune globulin, unless the father is also known to be Rh negative. In cases so severe that abscesses have formed in the ovaries and tubes, it may be necessary to remove the uterus by hysterectomy, and possibly other infected organs as well.
After successful treatment of a septic abortion, a woman may be tired for several weeks. In case of substantial bleeding, iron supplementation may be helpful. Sexual intercourse or the use of tampons should be avoided until recommended by the healthcare provider.
Treatment of septic abortion consists of maintaining blood pressure; monitoring the blood pressure, oxygenation, and urine output; antibiotics; and
Hemorrhage, due to uterine perforation, can often complicate the curettage for septic abortion.
A 34-year-old woman undergoes an elective termination of pregnancy at 12 weeks’ gestation. She develops fever, uterine tenderness, and is diagnosed with a septic abortion. Which of the following is the most likely mechanism of her infection?
A 22-year-old woman is diagnosed with a septic abortion after an incomplete abortion, fever, and uterine tenderness. She is treated with triple IV antibiotics and D&C of the uterus. After 48 hours of antibiotic therapy, she still has a fever of 102°F (38.8°C), BP of 80/40 mm Hg, and HR of 105 bpm. A computed tomography (CT) scan of the abdomen and pelvis is performed revealing pockets of air within the muscle of the uterus. Which of the following is the best treatment for this patient?
The correct answer is D. You answered D.
This patient has a septic abortion which has been treated conventionally with IV antibiotics and D&C to remove the nidus of the infection. She is still febrile and hypotensive despite antibiotic therapy for 48 hours. Also, due to the pockets of gas noted on CT scan, she likely has a necrotizing metritis, with gas-forming bacteria such as Clostridial species. Hysterectomy should be performed urgently as she may suffer severe morbidity or mortality if the procedure is delayed.
A 32-year-old G1P0 Hispanic female at 29 weeks’ gestation presents to the obstetrical triage unit complaining of fever, chills, and nausea and vomiting of 3 days duration. She also has myalgias. She denies leakage of fluid per vagina and states that she has been in good health. She has not been out of the country for 2 years. Questions about dietary habits reveal that she does not eat raw or uncooked foods, does not eat raw shellfish, but she does eat a fair amount of soft goat cheese. Her temperature is 101°F (38.33°C), BP is 100/80 mm Hg, and HR is 110 bpm. Her abdominal examination reveals tenderness of the uterine fundus. The fetal heart rate is 170 bpm. An ultrasound reveals a single gestation that is viable consistent with 29 weeks’ gestational age, and a normal amniotic fluid volume. An amniocentesis is performed revealing greenish dark fluid, and a Gram stain of the amniotic fluid shows gram-positive rods. Which of the following is the most likely diagnosis?
The correct answer is C.
Chorioamnionitis, also called intra-amniotic infection, almost always complicates pregnancies with rupture of membranes. One exception to this rule is the Gram-positive rod Listeria monocytogenes, which can be acquired through unpasteurized milk products such as soft goat cheese. The bacterial infection in the maternal gastrointestinal tract, which presents as a flu-like illness, then is spread hematogenously to the fetus, through the placenta. The diagnosis is largely from clinical suspicion and confirmed by amniocentesis. Often the amniotic fluid is meconium stained, and Gram-positive rods may be seen on Gram stain. The microbiology laboratory should be alerted not to dismiss this finding as skin (bacteroid) contaminants. Treatment is with IV ampicillin. Many times, the infection may be treated with antibiotic therapy and avoid delivery (again, an exception to the usual rule of needing to deliver the baby in chorioamnionitis). Listeria can also cause miscarriage and septic abortion.