eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Abortion, Septic

Author: Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Contributor Information and Disclosures

Updated: Dec 17, 2008

Introduction

Background

A septic abortion is a spontaneous or therapeutic/artificial abortion complicated by a pelvic infection.

Pathophysiology

Infection usually begins as endometritis and involves the endometrium and any retained products of conception. If not treated, the infection may spread further into the myometrium and parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common complication of septic abortion.

Mortality/Morbidity

  • Septic abortion was once the leading cause of maternal death around the world. The condition remains a primary cause of maternal mortality in the developing world, mostly as a result of illegal abortions.
  • In the US, mortality from septic abortion rapidly declined after legalization of abortion. Death now occurs in less than 1 per 100,000 abortions. Figures for most European countries are similar to US rates.
  • The risk of death from septic abortion rises with the progression of gestation.

Clinical

History

  • Any woman of childbearing age presenting with fever, abdominal pain, vaginal discharge, or vaginal bleeding should be evaluated for a possible septic abortion.
  • Patients with septic abortion usually present with complaints including the following:
    • Fever
    • Abdominal pain
    • Vaginal discharge
    • Vaginal bleeding
    • History of recent pregnancy

Physical

  • Perform an abdominal examination with attention to guarding, rebound tenderness, and bowel sounds.
  • Perform a pelvic examination to assess vaginal discharge, bleeding, cervical motion tenderness, uterine and adnexal tenderness, and masses.

Causes

Two major factors contribute to development of septic abortion.

  • Retained products of conception due to incomplete spontaneous or therapeutic abortion
  • Introduction of infection into the uterus. Pathogens causing septic abortion usually are mixed and derived from normal vaginal flora and sexually transmitted bacteria. These organisms include the following:
    • Escherichia coli and other aerobic, enteric, gram-negative rods
    • Group B beta-hemolytic streptococci
    • Staphylococcal organisms
    • Bacteroides species
    • Neisseria gonorrhoeae
    • Chlamydia trachomatis
    • Clostridium perfringens
    • Mycoplasma hominis
    • Haemophilus influenzae

More on Abortion, Septic

Overview: Abortion, Septic
Differential Diagnoses & Workup: Abortion, Septic
Treatment & Medication: Abortion, Septic
Follow-up: Abortion, Septic
References
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References

  1. Cates W, Rochat RW, Grimes DA, Tyler CW Jr. Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976). Am J Obstet Gynecol. Sep 15 1978;132(2):211-4. [Medline].

  2. Chatterjee C, Joardar GK, Mukherjee G, Chakraborty M. Septic abortions: a descriptive study in a teaching hospital at North Bengal, Darjeeling. Indian J Public Health. Jul-Sep 2007;51(3):193-4:[Medline].

  3. CherpesTL, Kusne S, Hillier SL. Haemophilus influenzae septic abortion. Infec Dis Obstet Gynecol. 2002;10(3):161-4. [Medline].

  4. Finkielman JD, De Feo FD, Heller PG, Afessa B. The clinical course of patients with septic abortion admitted to an intensive care unit. Intensive Care Med. Jun 2004;30(6):1097-102. [Medline].

  5. Jewett JF. Septic induced abortion. N Engl J Med. Oct 4 1973;289(14):748-9. [Medline].

  6. Kollef MH, Schuster DP. The acute respiratory distress syndrome. N Engl J Med. Jan 5 1995;332(1):27-37. [Medline].

  7. Osazuwa H, Aziken M. Septic abortion: a review of social and demographic characteristics. Arch Gynecol Obstet. Feb 2007;275(2):117-9:[Medline].

  8. Rana A, Pradhan N, Gurung G, Singh M. Induced septic abortion: a major factor in maternal mortality and morbidity. J Obstet Gynaecol Res. Feb 2004;30(1):3-8. [Medline].

  9. Rochelson B, Scher L, Warshawsky R, Simon D. Use of a temporary vena cava filter in a woman with septic abortion and inferior vena cava thrombosis. A case report. J Reprod Med. Jul 2003;48(7):557-9. [Medline].

  10. Scott JR. Early pregnancy loss (septic abortion). In: Danforth's Obstetric and Gynecology. Lippincott-Raven Publishers; 1994:179.

  11. Soper DE. Abortion and clostridial toxic shock syndrome. Obstet Gynecol. Nov 2007;110(5):970-1:[Medline].

  12. Stevenson MM, Radcliffe KW. Preventing pelvic infection after abortion. Int J STD AIDS. Sep-Oct 1995;6(5):305-12. [Medline].

  13. Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med. Aug 4 1994;331(5):310-4. [Medline].

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Further Reading

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Keywords

septic abortion, miscarriage, spontaneous abortion, therapeutic abortion, artificial abortion, pelvic infection, pelvic inflammatory disease, PID

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Contributor Information and Disclosures

Author

Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Slava V Gaufberg, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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