SEPTIC ABORTION

Clinical Features

As shown in Table

Investigations

  • As for threatened abortion
  • Blood cultures for patients in endotoxic shock

Management

  • Admit:
    • All cases having evidence of septic abortion
    • All patients in endotoxic shock
    • Where laparotomy is indicated.
    • Where pelvic abscess develops
  • Resuscitate as in incomplete abortion.
  • If presentation is late or the sepsis is severe: Give IV crystalline penicillin 3 mega units 6 hourly and IV gentamicin 80mg 8 hourly + IV metronidazole 500mg 8 hourly for 3–5 days, also, IM diclofenac 75mg 12 hourly.
  • If presentation is early and sepsis is mild: Give PO doxycycline 100mg 12 hourly OR PO amoxicillin/clavulanate 375mg 8 hourly.
  • Plus PO metronidazole 500mg 8 hourly for 7 days plus PO ibuprofen 400mg 8 hourly for 5 days.
  • In severe cases, evacuate the uterus with MVA soon after initial antibiotic doses. In mild cases give misoprostrol 600μg orally to achieve expulsion of the POCs.
  • Once stable, then may discharge on the above oral antibiotics and a pain killer.

Patient Education

As in complete abortion.