Define septic abortion how will you manage a case of septic abortion. Septic abortion

Q.4. Define septic abortion how will you manage a case of septic abortion.

Septic abortion-

The term septic abortion is often used to describes any of the types of abortion which become complicated by infection.

or,

Any abortion associated with clinical evidences of infection of the uterus and its contents is called septic abortion,

Manage a case of septic abortion for manage a case diagnosis and treatment are needed.

Diagnosis

1. Clinical features

i. Symptoms:-

1. H/O variable period of amenorrhoea, induced or spontaneous abortion.

2. High fever, chills and rigor.

3. Abdominal pain of varying degrees.

4. Offensive vaginal discharge.

5. General systemic upset Anorexoa, vomiting, Headache.

ii. Signs:-

1. Temperature raised (100-1050F)

2. Tachycardia.

3. Pallor

4. Sings of shock may present

5. Examination P/A

General abdominal rigidity, guarding and/or tenderness.

Lower abdomin is tenderness 

Abdominal distension,  ileus

6. Per vaginal examination 

Cervix feels soft, os may be open 

Foul smelling discharge

Uterus may feel soft/firm and small for period of amenorrhoea

2. Investigation-

1. Complete blood count

2. urine for R/M/E and C/S (R/M/E-Routine and microscopic examination, C/S-culture sensitivity

3. Blood grouping and cross matching

4. High vaginal swab (HBS) for C/S and gram staining.

5. Blood urea and serum creatinine.

6. X ray abdomen and pelvis.

7. USG of the uterus.

More.

3. Complication-

1. Immediates

1. Haemorrhage.

2. Injury

3. Spread of infection.

Endotoxic shock

Oliguria, Anuria and ARF.

Thrombophlebitis

2. Remote

Chronic debilety

Chronic pelvic pain.

Residual tubal infection.

secondary infertility

4. Treatment:-

1. Hospitalisation and should be kept in isolation.

2. Collection of high vaginal swab for c/s and microscopic examination.

3. Brood spectrum antibiotic for at least 5 days after collection swab for c/s

i. Inj cephradine 500 mg  6 hourly 

Metronidazole 400 mg  8 hourly

OR

ii. Inj Amoxacillin + Gentamycin 80 mg hourly  + Metronidazole.

4. Evacuation of the uterus after 12-24 hours of antibiotic therapy.

5. Treatment of complication

6. Other measures-

i. 1. v fluid (5% DA) to maintain hydration

ii. Blood transfusion if necessary 

iii. Hysterectomy any is indicated if there is possibility of gangrenous uterus.

iv. Inj syntometrine I.M to control bleeding.