Septic Abortion 

Definition

Septic abortion is defined as an abortion complicated by infection, which may follow spontaneous miscarriage or induced abortion. This is a life-threatening obstetric emergency that requires immediate recognition and management.

Etiology / Risk Factors

• Unsafe or incomplete abortion

• Retained products of conception after miscarriage or termination

• Poor aseptic technique during procedures

• Immunocompromised state (e.g., HIV, diabetes)

• Delayed presentation or self-administered abortion without medical supervision

Signs and Symptoms

1. Abdominal pain following abortion

2. Fever (may be mild to high)

3. Foul-smelling PV discharge, sometimes mixed with blood

4. Shock signs: tachycardia, hypotension, pallor

5. Jaundice may be present in severe sepsis

6. Tender uterus with possible rebound tenderness

7. Cervix: usually open

Investigations

• Full Blood Count / Differential Count (FBC/DC) to assess infection and anemia

• Endocervical swab for culture and sensitivity

• Blood cultures if systemic infection is suspected

• Group and cross-match for potential transfusion

• Ultrasound to check for retained products

• Bedside clotting time to evaluate coagulopathy

Management

Supportive Care

• Apply ABCD principles (Airway, Breathing, Circulation, Dehydration)

• IV fluids: RL/NS 3 liters or more in the first hour

• Blood transfusion if indicated

• Indwelling urethral catheter insertion

• Incomplete septic abortion: Resuscitate first, administer IV antibiotics, and wait at least 6 hours post-antibiotic initiation before uterine evacuation

Pharmacological Treatment

• Ceftriaxone 1 g IV every 12 hours for at least 5 days

• Metronidazole 500 mg IV every 8 hours for at least 5 days

Referral

• Transfer to hospital-level care with a nurse escort

• Ensure access to surgical intervention if required

Patient Education and Counselling

• Counsel about contraception post-abortion

• Educate on warning signs: persistent fever, excessive bleeding, foul-smelling discharge, abdominal pain

• Provide psychosocial support and link to reproductive health services

Summary / Key Points

1. Septic abortion: Infection complicating abortion; may be life-threatening

2. Clinical signs: Fever, abdominal pain, foul-smelling PV discharge, open cervix, shock

3. Investigations: FBC, cultures, ultrasound, blood group and cross-match

4. Management: ABCD resuscitation, IV antibiotics, fluids, blood transfusion if needed, surgical evacuation when safe

5. Patient counselling: Contraception, warning signs, psychosocial support