Any abortion associated with infection is called septic abortion. This is a type of abortion associated with sepsis of the product of conception and the uterus, commonly it is an incomplete variety but may be threatened or inevitable, either spontaneous or induced (criminal interference).
Causes of septic abortion: (1) Predisposing factors—Poor socio-economic condition — (a) criminal interference, (b) incomplete abortion, (c) criminal abortion. (2) Exciting factors—Presence of blood clots and a dead ovum or fetus from a good nidus for micro-organisms to grow.
Grades or degree of Septic Abortion: 1st Grades—Infection involving endometrium and myometrium. (2) Second Grades—Infection spreading to adnexa and pelvic structures. 3rd Grades— Generalized peritonitis
Clinical Features: Symptoms — (1) the patient may be single, married or widow. (2) Amenorrhoea followed by spontaneous or induced abortion. (3) Mostly history of some interference is present. (4) Foul smelling vaginal discharge.
(5) Severe abdominal pain. (6) Nausea and vomiting may be present. (7) High temperature (102 to 104°F), temperature comes with chill, rigor and shivering.
Signs — (1) Signs of blood loss may present. (2) Pallor, high temperature, toxemia, bacteraemia shock etc. may be present, (3) Uterus is firm and tender. (4) Cervix closed. (5) Foul smelling purulent pus like discharge from the genital tract.
Investigations: (1) Blood test—Leucocytosis above 1 5, 00 per cu. mm. (2) Temperature above 100°F (usually 102 to 104°F). (3) Foul smelling pinkish discharge per vagina. (4) Extra -— uterine spread of infection. (5) Features of other complications, e.g. peritonitis, renal failure, endotoxic shock may be present. (6) Urine analysis, uterine discharges (gram staining-aerobic and anaerobic culture and sensitivity determination), blood culture prior to antibiotic therapy. (7) X-ray of chest — it helps to diagnose pneumonia associated with spontaneous abortion or multiple pulmonary embolisms from septic thrombophlebitis. (8) Serum electrolytes — Estimation of electrolytes is helpful for the management of fluid and electrolyte disturbances.
Management: (i) History taking and examination of the patient. (2) Sedative (if necessary). (3) Control of sepsis (infection) with appropriate antibiotics. (4) Correct the blood volume and treat the endotoxic shock. (5) Empty the uterus.
(6) Treat the complications — Renal failure, pelvic abscess.
Septic abortion usually presents in two forms—one with endotoxic shock and the other without shock.