CURRENT Essentials of Critical Care.pdf

Chapter 20 Pregnancy 291■■■Septic AbortionEssentials of Diagnosis• Sepsis syndrome following recent spontaneous or induced pregnancytermination• Crampy pelvic pain with serosanguineous or purulent vaginaldischarge occurring within 7 days of recent pregnancy terminationor other intrauterine instrumentation• Hematuria and shock can develop rapidly• Abdominal and pelvic exam with tenderness and possible peritonealsigns; dilated cervix, lacerations, products of conception,bleeding, discharge• Blood, urine, and cervical specimens should be obtained for culture• Polymicrobial infection with aerobic and anaerobic organisms;Clostridium species important pathogens and suggested by largegram-positive rods on Gram stain• Abdominal radiographs helpful in diagnosis of uterine or bowelperforation; gas in myometrium noted on radiographs consistentwith clostridial infection and carries grave prognosis; ultrasoundto assess for presence of retained products of conception or detectingpossible pelvic abscesses• Likelihood of complications increases with later abortions orwith dilation and evacuation proceduresDifferential Diagnosis• Perforated viscus • Puerperal sepsis• Septic shock from prolonged rupture of membranesTreatment• Prompt broad-spectrum antibiotics followed by planned uterineevacuation procedure• Hysterectomy may be life saving if clostridial infection suspectedby discolored dusky uterus with myonecrosis or crepitation• Supportive management of accompanying complications includingARDS, hypotension, anemia, shock■ PearlSeptic abortion is usually a polymicrobial infection with aerobic andanaerobic bacteria including sexually transmitted pathogens andClostridial species.ReferenceTamussino K: Postoperative infection. Clin Obstet Gynecol 2002;45:562.(PMID: 12048413)