Septic miscarriage

Any abortion associated with clinical evidences of infection of uterus and its contents

1. SEPTIC MISCARRIAGE

2. DEFINITION Any abortion associated with clinical evidences of infection of uterus and its contents

3. Causes

4. Pathophysiology

5. 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 countries 47 000 women die from complications of unsafe abortion each year. Deaths due to unsafe abortion remain close to 13% of all maternal deaths.

6. Prevalance of Unsafe Abortion(WHO)

7. Signs and Symptoms Fever 38 C or more for at least 24 hrs Offensive or purulent vaginal discharge Lower abdominal pain , tenderness or mass. Tachycardia of more than 100 per min. History of pregnancy

8. SEPTIC SHOCK

9. Investigations Blood Full blood count: infection, anemic Beta human chorionic gonadotropin Renal Profile: renal failure 2 nd septic shock Blood group and cross match ESR: suspected infection Blood culture and sensitivity: if patient is febrile and systemic infection is suspected

10. Swab : endocervical swab for culture and sensitivity DIC: fibrinogen level, fibrin degradation product and d-dimer Urinalysis TVS: TRO ectopic, retained POC, adnexal mass, free fluid in cul-de-sac

11. Management

12. Acute Management Administer intravenous fluids through a large-bore angiocatheter unstable, administer oxygen and insert a Foley catheter. Early antibiotic treatment may be guided by Gram stain, but broad-spectrum coverage is recommended.

13. Posterior Colpotomy

14. Laparotomy

15. Hysterectomy