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Background

A septic abortion is a spontaneous or therapeutic/artificial abortion complicated by a pelvic


infection.
Pathophysiology
Infection usually begins as endometritis and involves the endometrium and any retained products
of conception. If not treated, the infection may spread further into the myometrium and
parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and
sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common
complication of septic abortion.

History
• Any woman of childbearing age presenting with fever, abdominal pain, vaginal
discharge, or vaginal bleeding should be evaluated for a possible septic abortion.
• Patients with septic abortion usually present with complaints including the following:
○ Fever
○ Abdominal pain
○ Vaginal discharge
○ Vaginal bleeding
○ History of recent pregnancy
Physical
• Perform an abdominal examination with attention to guarding, rebound tenderness, and
bowel sounds.
• Perform a pelvic examination to assess vaginal discharge, bleeding, cervical motion
tenderness, uterine and adnexal tenderness, and masses.
Causes
Two major factors contribute to development of septic abortion.

• Retained products of conception due to incomplete spontaneous or therapeutic abortion


• Introduction of infection into the uterus. Pathogens causing septic abortion usually are
mixed and derived from normal vaginal flora and sexually transmitted bacteria. These
organisms include the following:
○ Escherichia coli and other aerobic, enteric, gram-negative rods
○ Group B beta-hemolytic streptococci
○ Staphylococcal organisms
○ Bacteroides species
○ Neisseria gonorrhoeae
○ Chlamydia trachomatis
○ Clostridium perfringens
○ Mycoplasma hominis
○ Haemophilus influenzae
septic abortion that associated with serious infection of the uterus leading to
generalized infection.
abortion /abor·tion/ (ah-bor´shun)
1. expulsion from the uterus of the products of conception before the fetus is viable.
2. premature stoppage of a natural or a pathological process.
septic abortion
n.
Abortion complicated by fever, endometritis, and parametritis, often leading to sepsis.
septic abortion
Etymology: Gk, septikos, putrid
spontaneous or induced termination of a pregnancy in which the mother's life may be threatened
because of the invasion of germs into the endometrium, myometrium, and beyond. The woman
requires immediate and intensive care, massive antibiotic therapy, evacuation of the uterus, and
often emergency hysterectomy to prevent death from overwhelming infection and septic shock.
Compare infected abortion. See also illegal abortion, induced abortion.

What is going on in the body?


The uterus of a pregnant woman is normally protected by a plug of mucus in the cervix, as well
as the membranes surrounding the unborn child. A septic abortion can occur when bacteria enter
the uterus through the mucus plug. These bacteria can be introduced by unclean tools used
during an elective abortion. The bacteria may also be those that normally live in a woman's
vagina.

If the woman has a sexually transmitted infection (STI) such as chlamydia, the bacteria causing
the infection can spread through the unborn child or placenta, to the lining of the uterus. It may
go into the muscles of the uterus or beyond that to other nearby organs. If the infection reaches
the bloodstream, it is called sepsis.

What are the signs and symptoms of the condition?


A woman with a septic abortion is seriously ill, with the following symptoms that are related to
the infection:
• high fever, usually above 101 degrees F

• chills

• severe abdominal pain or cramping

• prolonged or heavy vaginal bleeding

• foul-smelling vaginal discharge


• backache

As the condition becomes more serious, signs of shock may appear. These include:
• low blood pressure

• low body temperature

• little or no urine output

• trouble breathing

If the septic abortion is not treated quickly and effectively, the woman may die.

What are the causes and risks of the condition?


A septic abortion may be caused by any of the following factors: the membranes
surrounding the unborn child have ruptured, sometimes without being detectedthe
woman has a sexually transmitted infection, such as chlamydiaan intrauterine
device (IUD) was left in place during the pregnancytissue from the unborn child or
placenta is left inside the uterus after a miscarriage or abortionattempts were made
to end the pregnancy, often illegally, by inserting tools, chemicals, or soaps into the
uterusRU-486 was used for a medical abortion

What can be done to prevent the condition?


Better birth control and legal abortion have dramatically reduced the number of
septic abortions. To cut the risk further, a woman should be tested for common
sexually transmitted infections in the first trimester of her pregnancy. If a woman
thinks she might be miscarrying or has miscarried, she should call her healthcare
professional immediately. It may be too late to save the pregnancy, but good follow-
up care can prevent an infection.

How is the condition diagnosed?


A septic abortion is diagnosed when a woman has a temperature of at least 101 F,
plus other signs and symptoms of the condition. Other reasons for the fever, such
as a cold or urinary tract infection, must be ruled out. As a result, a physical exam
and pelvic exam will be done.

Septic abortion: An abortion associated with a uterine infection. The infection can
occur during or just before or after an abortion. The infection can result from factors
such as Chlamydia, IUD's or attempted abortion using infected tools. More detailed
information about the symptoms,
Symptoms of Septic abortion
The list of signs and symptoms mentioned in various sources for Septic abortion includes the 17
symptoms listed below:
• Fever
• Chills
• Abdominal pain
• Abdominal cramping
• Prolonged vaginal bleeding
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Backache
• Low blood pressure
• Low body temperature
• Reduced urine output
• Absent urine output
• Breathing problems
• Septic shock
• Hypothermia
• Reduced blood pressure
• Fetal death
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Dilation and curettage


(D&C)

Background

Abortion
Surgical
type

First use Late 19th


century

Gestation 4-12 weeks

Usage

WHO recommends only


when manual vacuum
aspiration is unavailable

United 1.7% (2003)


States

Medical notes

Undertaken under heavy


sedation or general anesthesia.
Risk of perforation. Day-case
procedure

Infobox references

Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the
cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by
scraping and scooping (curettage). It is a therapeutic gynecological procedure as well as a rarely
used method of first trimester abortion.[1][2]
D&C normally refers to a procedure involving a curette, also called sharp curettage.[1] However,
some sources use the term D&C to refer more generally to any procedure that involves the
processes of dilation and removal of uterine contents, which includes the more common suction
curettage procedures of manual and electric vacuum aspiration.[3]

Contents
[hide]
• 1 Procedure
• 2 Clinical uses
• 3 Complications
• 4 See also
• 5 External links
• 6 References

[edit] Procedure
The first step in a D&C is to dilate the cervix, usually done a few hours before the surgery. The
woman is usually put under general anesthesia before the procedure begins. A curette, a metal
rod with a handle on one end and a sharp loop on the other, is inserted into the uterus through the
dilated cervix. The curette is used to gently scrape the lining of the uterus and remove the tissue
in the uterus. This tissue is examined for completeness (in the case of abortion or miscarriage
treatment) or pathologically for abnormalities (in the case of treatment for abnormal bleeding).[1]

[edit] Clinical uses


D&Cs are commonly performed to resolve abnormal uterine bleeding (too much, too often or too
heavy a menstrual flow);[2] to remove the excess uterine lining in women who have conditions
such as polycystic ovary syndrome (which cause a prolonged buildup of tissue with no natural
period to remove it);[citation needed] to remove tissue in the uterus that may be causing abnormal
vaginal bleeding,[1] including postpartum retained placenta;[citation needed] to remove retained tissue
(also known as retained POC or retained products of conception) in the case of a missed or
incomplete miscarriage;[3] and as a method of abortion that is now uncommon.[1]
Because medical and non-invasive methods of abortion now exist, and because D&C requires
heavy sedation or general anesthesia and has higher risks of complication, the procedure has
been declining as a method of abortion. The World Health Organization recommends D&C as a
method of surgical abortion only when manual vacuum aspiration is unavailable.[4] According to
the Centers for Disease Control and Prevention, D&C only accounted for 2.4% of abortions in
the United States in the year 2002,[5] down from 23.4% in 1972.[6]

[edit] Complications
One risk of sharp curettage is uterine perforation. Although normally no treatment is required for
uterine perforation, a laparoscopy may be done to verify that bleeding has stopped on its own.
Infection of the uterus or fallopian tubes is also a possible complication, especially if the woman
has an untreated sexually transmitted infection.[1]
Another risk is intrauterine adhesions, or Asherman's syndrome. One study found that in women
who had one or two sharp curettage procedures for miscarriage, 14-16% developed some
adhesions.[7] Women who underwent three sharp curettage procedures for miscarriage had a 32%
risk of developing adhesions.[7] The risk of Asherman's syndrome was found to be 30.9% in
women who had D&C following a missed miscarriage [8], and 25% in those who had a D&C 1–4
weeks postpartum.[9][10][11] Untreated Asherman's syndrome, especially if severe, also increases
the risk of complications in future pregnancies, such as ectopic pregnancy, miscarriage, and
abnormal placentation (eg.placenta previa).[1] According to recent case reports, use of vacuum
aspiration can also lead to intrauterine adhesions.[12]

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Curettage
(D&C)
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D&C done? • MS Rx Options
• What are
reasons not
to perform a
D&C? Dilation and Curettage (D&C)
• Pre-op: What Menstruation »
happens What is menstruation?
before
surgery? Menstruation is a woman's monthly bleeding, also called a period. When
you menstruate, your body is shedding the lining of the uterus (womb).
• What type of
anesthesia
Menstrual blood flows from the uterus through the small opening in the
is used for a cervix, and passes out of the body through the vagina. Most menstrual
D&C? periods last from three to five days.
• How is a What is the menstrual cycle?
D&C Menstruation is part of the menstrual cycle, which prepares your body for
performed? pregnancy each month. A cycle is counted from the first day of one period
• What are to the first day of the next period. The average menstrual cycle is 28 days
possible long. Cycles can range anywhere from 21 to 35 days in adults and from 21
complication to 45 days in young teens.
s of a D&C? Body chemicals called hormones rise and fall during the month to make
• What the menstrual cycle happen.
happens
after a D&C? What happens during the menstrual cycle?
• Why is the
D&C In the first half of the cycle, levels of estrogen (the &q...
procedure
Read the Menstruation article »
becoming
less
common?
What is dilation
and curettage
(D&C)?
Dilation and curettage
(D&C) is a procedure
in which the cervix of
the uterus is expanded
(dilated) so that the
uterine lining
(endometrium) can be
removed with a
spoon-shaped
instrument called a
curet or curette. The
procedure is
performed for a
variety of reasons.
Most commonly, this
surgery is done in
order to help
determine the cause
of abnormal uterine
bleeding. It can also
be done to help
determine the degree
of abnormality of the
endometrium in cases
of cancer or pre-
cancerous cells that
are detected by an in-
office biopsy. D&C is
also sometimes
necessary to remove
tissue after a
miscarriage.
Why is a D&C
done?
In general, a D&C is
used to help
determine the health
of the uterine lining or
to remove abnormal
tissue. Occasionally,
the procedure can
correct some of the
problems in the uterus
such as polyps, scar
tissue, or tissue
overgrowth.
What are reasons
not to perform a
D&C?
There are very few
contraindications to
D&C. Generally if a
patient is too ill to
undergo surgery, then
she should probably
not have this
procedure.
Furthermore, if the
patient is unable to
move her legs apart,
such as with severe
arthritis in the hips,
the surgeon may not
be able to perform the
procedure since it
requires enough
movement of the legs
to accommodate a
speculum and the
surgeon. If the patient
is pregnant or thinks
that she could be
pregnant, she should
not have the operation
unless the D&C is for
the purpose of an
abortion.
Pre-op: What
happens before
surgery?
Before a D&C, the
same general
recommendations as
for other outpatient
procedures apply. It is
recommended that the
patient take nothing
by mouth (food,
water, etc.) for at least
7 hours before the
scheduled operation.
Often, the doctor will
see the patient the day
before surgery to
discuss the procedure
and the potential
complications in
greater detail.
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• Dilation and
Curettage
Index
• Glossary

Next: What type of


anesthesia is used
for a D&C? »

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