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Septic Abortion


Presentation

  • Experience from this case suggests that cryptococcal infection should be considered in the differential diagnosis of pregnant women presenting with vague systemic symptoms such as fever, abdominal pain, and generalized lymphadenopathy.[ncbi.nlm.nih.gov]
Generalized Lymphadenopathy
  • Experience from this case suggests that cryptococcal infection should be considered in the differential diagnosis of pregnant women presenting with vague systemic symptoms such as fever, abdominal pain, and generalized lymphadenopathy.[ncbi.nlm.nih.gov]
Fever
  • Fever resolution time Sangines 1969 reported fever resolution time as a measure of effectiveness.[doi.org]
  • "Response to treatment was evaluated by the patient's 'fever index' expressed in degree-hour and defined as the total quantity of fever under the daily temperature curve with 99 F (37.2 C) as the baseline".There was no difference in duration of hospitalisation[ncbi.nlm.nih.gov]
  • "Response to treatment was evaluated by the patient's 'fever index' expressed in degree-hour and defined as the total quantity of fever under the daily temperature curve with 99 F (37.2 C) as the baseline".[cochrane.org]
Chills
  • Soluble fibrin monomer complexes (SFMC) were determined in patients with septic abortion (body temperatures of more than 39 degree C and/or chills without apparent signs of endotoxic shock), with infected abortion, with non-infected abortion and with[ncbi.nlm.nih.gov]
  • Symptoms and Signs Symptoms and signs of septic abortion typically appear within 24 to 48 h after abortion and are similar to those of pelvic inflammatory disease (eg, chills, fever, vaginal discharge, often peritonitis) and often those of threatened[msdmanuals.com]
  • Self-induced abortion using non-sterile methods Presence of a sexually transmitted infection such as chlamydia As a complication of pregnancy with an intrauterine device (IUD) A septic abortion is likely if a pregnant woman develops a fever with chills[fertilitysmarts.com]
  • Clinical features: – pyrexia : associated with the chills and rigors suggest blood stream spread of infection.[infofru.com]
  • In a woman with septic abortion, signs and symptoms that are related to the infection are mainly: High fever, usually above 101 F / 38 C Chills Severe abdominal pain and/or cramping /or strong perineal pressure Beginning miscarriage symptoms (heavy bleeding[en.wikipedia.org]
Rigor
  • Septicemia was defined by a positive blood culture rigors. Hypotension was assumed to be due to hemorrhage unless endotoxic shock was positively identified. Significant hemorrhage was also diagnosed if a blood transfusion was required.[ncbi.nlm.nih.gov]
  • Clinical features: – pyrexia : associated with the chills and rigors suggest blood stream spread of infection.[infofru.com]
  • . • Fever for 1day with no chills and rigor, max temp not recorded. • No h/o burning micturition, and increased frequency • No h/o SOB, palpitation, headache, dizziness and LOC. 4. Obs history: she is P2 A1 L2, 1St child : Fe, 18 yr.[slideshare.net]
Abdominal Pain
  • Perforation of the uterus during the abortion typically causes severe abdominal pain. Septic shock may result, causing hypothermia, hypotension, oliguria, and respiratory distress.[msdmanuals.com]
  • A 27-year-old woman at 10 weeks' gestation developed abdominal pain, fever, leukocytosis, peritoneal signs, closed cervix and a viable pregnancy. Progression from acute salpingitis to septic abortion was documented.[ncbi.nlm.nih.gov]
Right Shoulder Pain
  • A 43-year-old Japanese woman was evaluated in the outpatient department for right shoulder pain and fever, which began 5 days earlier. MRI of the right shoulder revealed a high-intensity area deep in the right trapezius muscle.[ncbi.nlm.nih.gov]
Shoulder Pain
  • A 43-year-old Japanese woman was evaluated in the outpatient department for right shoulder pain and fever, which began 5 days earlier. MRI of the right shoulder revealed a high-intensity area deep in the right trapezius muscle.[ncbi.nlm.nih.gov]
First Trimester Bleeding
  • Epidemiology Prevalence : First Trimester Bleeding in 25% of pregnant women III.[fpnotebook.com]
  • First-trimester bleeding in a pregnant woman has an extensive differential diagnosis ( Table 2 ) and should be evaluated with a full history and physical examination.[aafp.org]
Oliguria
  • On the other hand, reductions in both clearances were present in most patients who had a long period of oliguria (GFR: 84.9 /- 4.2 and RPF: 418.1 /- 33.1).[ncbi.nlm.nih.gov]
  • Septic shock may result, causing hypothermia, hypotension, oliguria, and respiratory distress.[msdmanuals.com]
  • 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).[en.wikipedia.org]
  • Blood transfusion: early and adequate blood transfusion is not only helpful to improve the body resistance and anaemia but is also affective to prevent or minimize shock and oliguria.[infofru.com]
  • Abortions induced by untrained birth attendants or dais, lady health visitors; or paramedics in dark rooms end up in sepsis, perforation of the uterus, peritonitis and acute renal failure (oliguria/anuria).[ispub.com]
Uterine Tenderness
  • All study subjects satisfied the following diagnostic criteria: pyrexia of equal to or greater than 38 C, tachycardia equal to or greater than 90/min, foul smelling vaginal discharge, uterine tenderness, adnexal tenderness, peritonitis, or features of[ncbi.nlm.nih.gov]
  • Symptoms and signs of abortion‐related infections include fever, pelvic/abdominal pain, prolonged vaginal bleeding, uterine tenderness, foul‐smelling uterine discharge, and elevated inflammatory markers, findings similar to those associated with pelvic[doi.org]
Uterine Tenderness
  • All study subjects satisfied the following diagnostic criteria: pyrexia of equal to or greater than 38 C, tachycardia equal to or greater than 90/min, foul smelling vaginal discharge, uterine tenderness, adnexal tenderness, peritonitis, or features of[ncbi.nlm.nih.gov]
  • Symptoms and signs of abortion‐related infections include fever, pelvic/abdominal pain, prolonged vaginal bleeding, uterine tenderness, foul‐smelling uterine discharge, and elevated inflammatory markers, findings similar to those associated with pelvic[doi.org]
Adnexal Tenderness
  • All study subjects satisfied the following diagnostic criteria: pyrexia of equal to or greater than 38 C, tachycardia equal to or greater than 90/min, foul smelling vaginal discharge, uterine tenderness, adnexal tenderness, peritonitis, or features of[ncbi.nlm.nih.gov]

Workup

  • Administer broad-spectrum antibiotics before completing diagnostic workup. [13] Failure to obtain information about recent termination of pregnancy may lead to a wrong diagnosis or delayed/inappropriate treatment.[emedicine.medscape.com]
Ovarian Mass
  • One of four conservatively managed tubo-ovarian masses spontaneously drained rectally.[ncbi.nlm.nih.gov]
Neisseria Gonorrhoeae
  • gonorrhoeae, and Chlamydia trachomatis are all possible pathogens. 8 , 46 In the United States, infection with Clostridium perfringens is largely associated with illegal abortions. 8 Recently Clostridium sordellii has been the cause of death in a small[glowm.com]
  • The presence of sexually transmitted infections at the time of abortion with organisms such as Chlamydia trachomatis or Neisseria gonorrhoeae is an established risk factor for septic abortion ( Barbacci 1986 ; Blackwell 1993 ).[doi.org]

Treatment

  • The most critical treatment of septic abortion remains the prompt removal of infected tissue. Antibiotic administration and fluid resuscitation provide necessary secondary levels of treatment.[doi.org]
  • It appears that cefoxitin was successful as a single agent in the treatment of septic abortion.[ncbi.nlm.nih.gov]
  • Antibiotic treatment is very important for the treatment of septic abortion. The recommended treatments include antibiotics that have effects on different types of bacteria.[cochrane.org]

Prognosis

  • This study is to evaluate, once again, the clinical management and prognosis of septic abortion, and to determine if present concepts of therapy are valid.The diagnosis of septic abortion is difficult to make with certainty.[nejm.org]

Etiology

  • The most common etiologic agents in septic abortion are those present in the normal flora of the female genital tract. The majority of septic abortions are polymicrobial infections, with participation of both aerobic and anaerobic bacteria.[popline.org]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Etiology and Risk Factors Chromosomal abnormalities are a direct cause of spontaneous abortion. One meta-analysis 9 found that a chromosomal abnormality occurs in 49 percent of spontaneous abortions.[aafp.org]

Epidemiology

  • EPIDEMIOLOGY • Septic abortion remains a primary cause of maternal mortality in the developing world, mostly as a result of illegal abortions • 21.6 million women experience an unsafe abortion worldwide each year; 18.5 million of these occur in developing[slideshare.net]
  • Epidemiology Prevalence : First Trimester Bleeding in 25% of pregnant women III.[fpnotebook.com]
  • Epidemiology Frequency United States Frequency of complications depends on gestational age (GA) at the time of miscarriage or abortion and method of abortion (see the Gestational Age from Estimated Date of Delivery calculator).[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Thus, updated knowledge of the pathophysiology, clinical presentation, microbes, and proper treatment is needed to optimally treat this emergency condition when it exists.[doi.org]
  • Pathophysiology Postabortion complications develop as a result of 3 major mechanisms as follows: incomplete evacuation of the uterus and uterine atony, which leads to hemorrhagic complications; infection; and injury due to instruments used during the[emedicine.medscape.com]

Prevention

  • Unpublished data from Bangladesh Association for Prevention of Septic Abortion (BAPSA), Dhaka, Bangladesh, 2012. Bangladesh Association for the Prevention of Septic Abortion (BAPSA), M.[freethesaurus.com]
  • Septic abortion provides a paradigm for preventive medicine, with opportunities for primary, secondary, and tertiary prevention 2 .Scope of the ProblemA 1973 report described an adolescent admitted to a large Boston teaching hospital with what proved[nejm.org]
  • Prevention Always keep in mind that prevention is better than cure! Therefore, here are a few ways to avoid Septic abortions. 1. Avoid Unintended Pregnancy It’s as simple as this! Use whatever means necessary to do so.[beautyglitch.com]
  • Septic abortion is a paradigm of preventive medicine, relating to all levels of prevention – primary, secondary, and tertiary. 2 In the past, obstetricians/gynecologists were often the experts in management of sepsis.[glowm.com]
  • Circumstances that can affect successful treatment include: age overall health degree of organ failure timing of the start of medical treatment Many cases of septic shock can’t be prevented.[healthline.com]

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