Septic abortion

Septic abortion

Abortion is said to be septic when it is complicated by infection.

Clinical presentation

• Moderate to severe abdominal pain following abortion

• Fever may be present

• Foul-smelling per vaginal discharge, which may be mixed with blood

• May be in shock

• Tender uterus with or without rebound tenderness

• Cervix is usually open

Management of septic abortion in dispensary and health centre

• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation

• Give compound sodium lactate (IV) or 0.9% sodium chloride (IV) in case of hypotension or shock. Avoid IV fluids in cases of chronic anaemia

• Insert an indwelling urethral catheter

• Obtain blood for Hb or Full Blood Count (FBC)

• Perform ultrasound if feasible

Pharmacological treatment

• Amoxicillin + clavulanic acid (FDC) (IV) 1.2 g every 8 hours for 24–48 hours

AND

• Metronidazole (IV) 500 mg every 8 hours for 24–48 hours

Referral

• Resuscitate and immediately refer the patient to a hospital with a nurse escort

Management in the hospital

• Perform Full Blood Count (FBC)

• Draw blood for culture and susceptibility testing

• Perform abdominal and pelvic ultrasound as appropriate

• Give IV Ringer's lactate or normal saline depending on individual patient needs

• Give blood transfusion if indicated

• Evacuate the uterus with a sharp wide curette under general anaesthesia

Pharmacological treatment

Treat as above and, when the patient is stable, continue with:

• Amoxicillin + clavulanic acid (FDC) (PO) 625 mg every 8 hours for 7 days

AND

• Metronidazole (PO) 400 mg every 8 hours for 7 days

If there is no response to the above antibiotics within 3 days, adjust treatment according to culture and sensitivity results or switch to:

• Ceftriaxone + sulbactam (FDC) (IV) 1.5 g every 12 hours for 5 days

AND

• Metronidazole (IV) 500 mg every 8 hours for 5 days

AND

• Ferrous sulfate + folic acid (FDC) (PO) 1 tablet daily for 4 weeks, then reassess

Patient education

• Counsel, educate, and provide an appropriate contraceptive method.