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Banwarth-Kuhn B, McQuade M, Krashin JW. Vaginal Bleeding Before 20 Weeks Gestation. Obstet Gynecol Clin North Am 2023; 50:473-492. [PMID: 37500211 DOI: 10.1016/j.ogc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Conditions that often present with vaginal bleeding before 20 weeks are common and can cause morbidity and mortality. Clinically stable patients can choose their management options. Clinically unstable patients require urgent procedural management: uterine aspiration, dilation and evacuation, or surgical removal of an ectopic pregnancy. Septic abortion requires prompt procedural management, intravenous antibiotics, and intravenous fluids. Available data on prognosis with expectant management of pre-viable rupture of membranes in the United States are poor for mothers and fetuses.
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Affiliation(s)
| | | | - Jamie W Krashin
- Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Manning S, Kuhn D. Spontaneous and Complicated Therapeutic Abortion in the Emergency Department. Emerg Med Clin North Am 2023; 41:295-305. [PMID: 37024165 DOI: 10.1016/j.emc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Pregnancy-related emergency department visits are common in the United States. Although typically managed safely in the outpatient setting, patients with spontaneous abortion may also present with life-threatening hemorrhage or infection. Management strategies for spontaneous abortion are similarly wide-ranging from expectant management to emergent surgical intervention. Surgical management of complicated therapeutic abortion is similar to that of spontaneous abortion. The dramatic changes in the legal status of abortion in the United States may have significant influence on the incidence of complicated therapeutic abortion, and we encourage emergency physicians to familiarize themselves with the diagnosis and management of these conditions.
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Althaqafi A, Munshi A, Altayib H, Alsubhi N, Alnajar D, Al-Amri A. Septic Abortion Secondary to Peptoniphilus asaccharolyticus Complicated by Bacteremia: A Case Report and Review of Literature. Cureus 2023; 15:e35978. [PMID: 37041893 PMCID: PMC10083041 DOI: 10.7759/cureus.35978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Peptoniphilus species are gram-positive anaerobic coccus (GPAC) that are found in the human flora, such as the skin, gastrointestinal tract, and genitourinary tract, and can be pathogenic. Septic abortion caused by Peptoniphilus species has been reported only three times in the literature. Here, we present a case of Peptoniphilus asaccharolyticus (P. asaccharolyticus) bacteremia as a complication of septic abortion.
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Wall LL, Yemane A. Infectious Complications of Abortion. Open Forum Infect Dis 2022; 9:ofac553. [PMCID: PMC9683598 DOI: 10.1093/ofid/ofac553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022] Open
Abstract
This article reviews the infectious complications of abortion (both spontaneous and induced) and the management of this condition. The key points are: (1) Making abortion illegal does not reduce its incidence or prevalence; rather, it only makes abortions unsafe, increasing the likelihood of infectious complications. (2) Timely recognition of developing sepsis in the pregnant patient is critical. This requires constant vigilance and a high index of suspicion. (3) Rapid intravenous administration of broad-spectrum antibiotics targeted to the likely intrauterine source of infection as soon as sepsis is diagnosed is critical to prevent severe sepsis, septic shock, and multisystem organ failure. (4) The mainstay of treatment is prompt evacuation of any residual products of conception from within the uterine cavity under broad-spectrum antibiotic cover targeting the likely intrauterine source of infection. (5) Prompt engagement of specialists in both critical care and obstetrics-gynecology is necessary to optimize outcomes in patients with septic abortion.
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Affiliation(s)
- L Lewis Wall
- Correspondence: L. Lewis Wall, Departments of Obstetrics & Gynecology and Anthropology, Washington University in St Louis, 1036 Dautel Ln, St Louis, MO 63146 ()
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Hans P, Sharma K. Misadventure of an Unsafe Abortion. Cureus 2022; 14:e31131. [DOI: 10.7759/cureus.31131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
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Kishan R, Wesley S, Barnett G, Kauffman RP. Septic abortion complicated by infective endocarditis, mitral valve vegetation, and septic and reactive arthritis: A case report. Case Rep Womens Health 2022; 34:e00398. [PMID: 35242597 PMCID: PMC8857651 DOI: 10.1016/j.crwh.2022.e00398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/13/2022] Open
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Capell-Morell M, Cubo-Abert M, Bradbury M, Rodriguez-Mias NL, Montero-Armengol A, Suárez-Salvador ME, Miranda Gómez I, Poza-Barrasus JL, Gil-Moreno A. Intra-Abdominal Retained Products of Conception: A Rare Complication Postsurgical Abortion by Dilation and Evacuation. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Melissa Bradbury
- Oncologic Gynecology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Ignacio Miranda Gómez
- Radiodiagnosis Service. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Antonio Gil-Moreno
- Oncologic Gynecology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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PrabhuDas M, Piper JM, Jean-Philippe P, Lachowicz-Scroggins M. Immune Regulation, Maternal Infection, Vaccination, and Pregnancy Outcome. J Womens Health (Larchmt) 2021; 30:199-206. [PMID: 33232632 PMCID: PMC8020511 DOI: 10.1089/jwh.2020.8854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
About 12.5% of all maternal deaths in the United States are due to infectious causes. This proportion, although stable during the past three decades, represents an increase in infectious causes of mortality, as the overall mortality rate in U.S. pregnant women had increased steadily during that same period. During healthy pregnancies, a delicate immunological balance-in which a mother's immune system tolerates the semi-allogeneic fetus yet maintains immune competency against infectious agents-is achieved and maintained. This immunological paradigm, however, results in increased susceptibility to infectious diseases during pregnancy, particularly in later stages and during the early postpartum period. The inflammatory process induced by these infectious insults, as well as some noninfectious insults, occurring during pregnancy can disrupt this carefully achieved balance and, in turn, lead to a state of rampant inflammation, immune activation, and dysregulation with deleterious health outcomes for the mother and fetus. Elucidating mechanisms contributing to the disruption of this immunologic homeostasis, and its disruption by infectious pathogens, might offer opportunities for interventions to reduce maternal and fetal morbidity and mortality.
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Affiliation(s)
- Mercy PrabhuDas
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Jeanna M. Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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Fouks Y, Samueloff O, Levin I, Many A, Amit S, Cohen A. Assessing the effectiveness of empiric antimicrobial regimens in cases of septic/infected abortions. Am J Emerg Med 2019; 38:1123-1128. [PMID: 31443937 DOI: 10.1016/j.ajem.2019.158389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Infected abortion is a life-threatening condition that requires immediate surgical and medical interventions. We aimed to assess the common pathogens associated with infected abortion and to test the microbial coverage of various empiric antimicrobial regimens based on the bacteriological susceptibility results in women with infected abortions. METHODS A retrospective study in a single university-affiliated tertiary hospital. Electronic records were searched for clinical course, microbial characteristics, and antibiotic susceptibility of all patients diagnosed with an infected abortion. The effectiveness of five antibiotic regimens was analyzed according to bacteriological susceptibility results. RESULTS Overall, 84 patients were included in the study. The mean age of patients was 32.3(SD ± 5.8) years, and the median gestational age was 15 (IQR 8-19) weeks. Risk factors for infection were identified in 23 patients (27.3%), and included lack of medical insurance (n = 12), recent amniocentesis/chorionic villus sampling or fetal reduction due to multifetal pregnancies (n = 10). The most common pathogens isolated were Enterobacteriaceae (35%), Streptococci (31%), Staphylococci (9%) and Enterococci (9%). The combination of intravenous ampicillin, gentamicin and metronidazole showed significant superiority over all the other tested regimens according to the susceptibility test results. Piperacillin-tazobactam as an empiric single-agent drug of choice and provided a superior microbial coverage, with a coverage rate of 93.3%. CONCLUSIONS A combination of ampicillin, gentamicin, and metronidazole had a better spectrum of coverage as a first-line empiric choice for patients with infected abortion.
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Affiliation(s)
- Yuval Fouks
- Lis Maternity Hospital, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel.
| | - Ofri Samueloff
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Lis Maternity Hospital, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
| | - Ariel Many
- Lis Maternity Hospital, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
| | - Sharon Amit
- The Department of Clinical Microbiology and Infectious Diseases, Hadassah University Hospital, Jerusalem, Israel
| | - Aviad Cohen
- Lis Maternity Hospital, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center (affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel
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Plesiomonas shigelloides: An Unusual Cause of Septic Abortion. Case Rep Infect Dis 2017. [PMID: 28634558 PMCID: PMC5467273 DOI: 10.1155/2017/9363707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Plesiomonas shigelloides, the only oxidase-positive Enterobacteriaceae, is an inhabitant of freshwater and estuary ecosystems. We report the first possible case of Plesiomonas shigelloides-induced septic abortion. This 24-year-old female was successfully treated by dilatation and curettage as well as antimicrobial therapy.
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Abstract
BACKGROUND A septic abortion refers to any abortion (spontaneous or induced) complicated by upper genital tract infection including endometritis or parametritis. The mainstay of treatment of septic abortion is antibiotic therapy alone or in combination with evacuation of retained products of conception. Regimens including broad-spectrum antibiotics are routinely recommended for treatment. However, there is no consensus on the most effective antibiotics alone or in combination to treat septic abortion. This review aimed to bridge this gap in knowledge to inform policy and practice. OBJECTIVES To review the effectiveness of various individual antibiotics or antibiotic regimens in the treatment of septic abortion. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and POPLINE using the following keywords: 'Abortion', 'septic abortion', 'Antibiotics', 'Infected abortion', 'postabortion infection'. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials on 19 April, 2016. SELECTION CRITERIA We considered for inclusion randomised controlled trials (RCTs) and non-RCTs that compared antibiotic(s) to another antibiotic(s), irrespective of route of administration, dosage, and duration as well as studies comparing antibiotics alone with antibiotics in combination with other interventions such as dilation and curettage (D&C). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from included trials. We resolved disagreements through consultation with a third author. One review author entered extracted data into Review Manager 5.3, and a second review author cross-checked the entry for accuracy. MAIN RESULTS We included 3 small RCTs involving 233 women that were conducted over 3 decades ago.Clindamycin did not differ significantly from penicillin plus chloramphenicol in reducing fever in all women (mean difference (MD) -12.30, 95% confidence interval (CI) -25.12 to 0.52; women = 77; studies = 1). The evidence for this was of moderate quality. "Response to treatment was evaluated by the patient's 'fever index' expressed in degree-hour and defined as the total quantity of fever under the daily temperature curve with 99°F (37.2°C) as the baseline".There was no difference in duration of hospitalisation between clindamycin and penicillin plus chloramphenicol. The mean duration of hospital stay for women in each group was 5 days (MD 0.00, 95% CI -0.54 to 0.54; women = 77; studies = 1).One study evaluated the effect of penicillin plus chloramphenicol versus cephalothin plus kanamycin before and after D&C. Response to therapy was evaluated by "the time from start of antibiotics until fever lysis and time from D&C until patients become afebrile". Low-quality evidence suggested that the effect of penicillin plus chloramphenicol on fever did not differ from that of cephalothin plus kanamycin (MD -2.30, 95% CI -17.31 to 12.71; women = 56; studies = 1). There was no significant difference between penicillin plus chloramphenicol versus cephalothin plus kanamycin when D&C was performed during antibiotic therapy (MD -1.00, 95% CI -13.84 to 11.84; women = 56; studies = 1). The quality of evidence was low.A study with unclear risk of bias showed that the time for fever resolution (MD -5.03, 95% CI -5.77 to -4.29; women = 100; studies = 1) as well as time for resolution of leukocytosis (MD -4.88, 95% CI -5.98 to -3.78; women = 100; studies = 1) was significantly lower with tetracycline plus enzymes compared with intravenous penicillin G.Treatment failure and adverse events occurred infrequently, and the difference between groups was not statistically significant. AUTHORS' CONCLUSIONS We found no strong evidence that intravenous clindamycin alone was better than penicillin plus chloramphenicol for treating women with septic abortion. Similarly, available evidence did not suggest that penicillin plus chloramphenicol was better than cephalothin plus kanamycin for the treatment of women with septic abortion. Tetracyline enzyme antibiotic appeared to be more effective than intravenous penicillin G in reducing the time to fever defervescence, but this evidence was provided by only one study at low risk of bias.There is a need for high-quality RCTs providing reliable evidence for treatments of septic abortion with antibiotics that are currently in use. The three included studies were carried out over 30 years ago. There is also a need to include institutions in low-resource settings, such as sub-Saharan Africa, Latin America and the Caribbean, and South Asia, with a high burden of abortion and health systems challenges.
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Affiliation(s)
- Atim Udoh
- College of Medical Sciences, University of CalabarObstetrics and GynaecologyCalabarCross River StateNigeria
| | - Emmanuel E Effa
- College of Medical Sciences, University of CalabarInternal MedicinePMB 1115CalabarCross River StateNigeria540001
| | - Olabisi Oduwole
- University of Calabar Teaching Hospital (ITDR/P)Institute of Tropical Diseases Research and PreventionMoore RoadCalabarCross River StateNigeria
| | - Babasola O Okusanya
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi‐ArabaExperimental and Maternal Medicine Unit, Department of Obstetrics and GynaecologyLagosNigeria
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Abstract
Worldwide, abortion accounts for approximately 14% of pregnancy-related deaths, and septic abortion is a major cause of the deaths from abortion. Today, septic abortion is an uncommon event in the United States. The most critical treatment of septic abortion remains the prompt removal of infected tissue. Antibiotic administration and fluid resuscitation provide necessary secondary levels of treatment. Most young physicians have never treated septic abortion. Many obstetrician-gynecologists experience, or plan to experience, global health activities and will likely care for women with septic abortion. Thus, updated knowledge of the pathophysiology, clinical presentation, microbes, and proper treatment is needed to optimally treat this emergency condition when it exists. The pathophysiology of septic abortion involves infection of the placenta, especially the maternal villous space that leads to a high frequency of bacteremia. Symptoms and signs range from mild to severe. The microbes involved are usually common vaginal bacteria, including anaerobes, but occasionally potentially very serious and lethal infection is caused by bacteria that produce toxins. The primary treatment is early curettage to remove infected and devitalized tissue even in the face of continued fetal heart tones. Important secondary treatments are the administration of fluids and antibiotics. Updated references of sepsis and septic shock are reviewed.
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Bajwa SJS, Bajwa SK, Ghuman GS. Pregnancy with co-morbidities: Anesthetic aspects during operative intervention. Anesth Essays Res 2015; 7:294-301. [PMID: 25885972 PMCID: PMC4173569 DOI: 10.4103/0259-1162.123207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Gagandeep Singh Ghuman
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Lombaard H, Adam S, Makin J, Sebola P. An audit of the initial resuscitation of severely ill patients presenting with septic incomplete miscarriages at a tertiary hospital in South Africa. BMC Pregnancy Childbirth 2015; 15:82. [PMID: 25886596 PMCID: PMC4384342 DOI: 10.1186/s12884-015-0510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic Hospital. Methods A retrospective audit was performed on all patients who presented to Steve Biko Academic Hospital with a septic incomplete miscarriage from 1st January 2008 to 31st December 2010. Data regarding patient demographics, initial presentation, resuscitation and disease severity was collected from the “maternal near-miss”/SAMM database and the patient’s medical record. The shock index was calculated for each patient retrospectively. Results There were 38 SAMM and 9 maternal deaths during the study period. In the SAMM group 86.8% and in the maternal death group 77.8% had 2 intravenous lines for resuscitation. There was no significant improvement in the mean blood pressure following resuscitation in the SAMM group (p 0.67), nor in the maternal death group (p 0.883). The shock index before resuscitation was similar in the two groups but improved significantly following resuscitation in the SAMM group (p 0.002). Only 31.6% in the SAMM group and 11.1% in the maternal death group had a complete clinical examination, including a speculum examination of the cervix on admission. No antibiotics were administered to 21.1% in the SAMM group and to 33.3% in the maternal death group. Conclusion The strict protocol management for patients with septic incomplete miscarriage was not adhered to. Physicians should be trained to recognise and react to the seriously ill patient. The use of the shock index in the identification and management of the critically ill pregnant patient needs to be investigated.
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Affiliation(s)
- Hennie Lombaard
- Maternal and Fetal Medicine Unit, Department Obstetrics and Gynecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
| | - Sumaiya Adam
- Maternal and Fetal Medicine Unit, Department Obstetrics and Gynecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
| | - Jennifer Makin
- Department of Obstetrics and Gynecology, University of Pretoria, Pretoria, South Africa. .,Medical Research Council Maternal and Infant Health Strategies Research Unit, University Pretoria, Pretoria, South Africa.
| | - Patricia Sebola
- Department of Obstetrics and Gynecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
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Abstract
Maternal sepsis is relatively common. Most of these infections are the result of tissue damage during labor and delivery and physiologic changes normally occurring during pregnancy. These infections, whether directly pregnancy-related or simply aggravated by normal pregnancy physiology, ultimately have the potential to progress to severe sepsis and septic shock. This article discusses commonly encountered entities and septic shock. The expeditious recognition of common maternal sepsis and meticulous attention to appropriate management to prevent the progression to severe sepsis and septic shock are emphasized. Also discussed are principles and new approaches for the management of septic shock.
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Affiliation(s)
- Jamie Morgan
- Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulopathy following midtrimester genetic amniocentesis. Infect Dis Obstet Gynecol 2012; 5:386-90. [PMID: 18476193 PMCID: PMC2364589 DOI: 10.1155/s1064744997000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/1997] [Accepted: 02/12/1998] [Indexed: 11/18/2022] Open
Abstract
Background: Midtrimester genetic amniocentesis is a commonly performed procedure, with acknowledgment of some risk to mother and fetus. Case: We present an unusual case of midtrimester genetic amniocentesis with bowel injury and resulting septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. A total abdominal hysterectomy and bilateral salpingoophorectomy were required for resolution of sepsis. The patient also required prolonged ventilatory support postoperatively. Conclusion: Although relatively safe, genetic amniocentesis can result in serious morbidity, and attention to technique should be maintained.
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Rios FG, Risso-Vázquez A, Alvarez J, Vinzio M, Falbo P, Rondinelli N, Bienzobas DH. Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit. Int J Gynaecol Obstet 2012; 119:136-40. [DOI: 10.1016/j.ijgo.2012.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/15/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
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Themistoklis SN, Chrysovalantis V, Stylianos A, Nikolaos KL, Efthymia A. CT Diagnosis of an Abortion-Related Retroperitoneal Space Abscess. J Clin Med Res 2012; 3:268-9. [PMID: 22383917 PMCID: PMC3279491 DOI: 10.4021/jocmr509w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 11/29/2022] Open
Abstract
A female patient with a history of recent abortion was transferred in critically ill condition in our hospital. CT imaging on emergency basis depicted an abscess in the right retroperitoneal space that included the head of fetus, along with rupture of the right lateral wall of uterus. Spiral CT enabled prompt diagnosis and therapy of this rare abortion-related complication.
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Gravett CA, Gravett MG, Martin ET, Bernson JD, Khan S, Boyle DS, Lannon SMR, Patterson J, Rubens CE, Steele MS. Serious and life-threatening pregnancy-related infections: opportunities to reduce the global burden. PLoS Med 2012; 9:e1001324. [PMID: 23055837 PMCID: PMC3467240 DOI: 10.1371/journal.pmed.1001324] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Michael Gravett and colleagues review the burden of pregnancy-related infections, especially in low- and middle-income countries, and offer suggestions for a more effective intervention strategy.
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Affiliation(s)
- Courtney A Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's Hospital, Seattle, WA, USA.
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Savaris RF, de Moraes GS, Cristovam RA, Braun RD. Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study. Am J Obstet Gynecol 2011; 204:301.e1-5. [PMID: 21195382 DOI: 10.1016/j.ajog.2010.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 09/17/2010] [Accepted: 11/02/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to investigate whether oral antibiotics are necessary, after 48 hours of clinical improvement, in uncomplicated septic abortion. STUDY DESIGN In a randomized double-blind clinical trial, 56 women with uncomplicated septic abortion were treated with intravenous antibiotics, followed by uterine evacuation. On hospital discharge (day 1), patients were randomized to receive either oral doxycycline plus metronidazole or placebo, until completing 10 days of treatment. Clinical cure was defined by the absence of fever (<37.7°C), reduced vaginal bleeding, and minimal or no pelvic pain. RESULTS Cure was observed in all 56 patients. The institutional review board stopped the treatment arm as it was adding risk with no further benefit to the patients. An observational cohort with additional 75 cases was followed up in the no treatment arm and no failure was identified (probability of an adverse event, 0%; 95% confidence interval, 0-0.03). CONCLUSION After 48 hours of clinical improvement, antibiotics may not be necessary.
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Matsubara S, Saito Y, Shimada K, Morisawa Y, Toshima M, Fujita A, Izumi A, Suzuki M. Non-surgical management of post-cesarean uterine infection with marked myometrial gas formation. J Obstet Gynaecol Res 2010; 36:1240-4. [PMID: 21040210 DOI: 10.1111/j.1447-0756.2010.01315.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Gas in an infected organ generally indicates a severe infection, often requiring surgery; however, data are lacking as to post-cesarean gas-forming uterine infection. A 27-year-old Japanese primigravida underwent a difficult cesarean section, after which a high fever continued. Computed tomography (CT) revealed marked gas in the uterine anterior myometrium. Diagnosing this condition as post-cesarean uterine scar infection, we recommended surgical intervention, that is, hysterectomy or at least drainage; however, the patient refused it. Considering the patient's desire and lack of organ-failure signs, we employed intensive antibiotic treatment for 6 weeks. Serial CT indicated a gradual decrement in the gas amount and she recovered completely after 8 weeks. This case suggests that surgical procedure may not always be necessary for post-cesarean gas-forming uterine infection and CT may be useful to detect/follow this condition.
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Affiliation(s)
- Shigeki Matsubara
- Departments of Obstetrics and GynecologyInfection Prevention and ControlInfectious DiseasesRadiology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Severity of infection following the introduction of new infection control measures for medical abortion. Contraception 2010; 83:330-5. [PMID: 21397090 DOI: 10.1016/j.contraception.2010.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/30/2010] [Accepted: 08/30/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND In response to concerns about serious infections following medical abortion, in early 2006 the Planned Parenthood Federation of America changed the route of misoprostol administration from vaginal to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, the Planned Parenthood Federation of America began requiring routine antibiotic coverage for all medical abortions. We previously reported a pronounced drop in the rate of serious infections following the adoption of these new infection control measures. Our objective in this study was to assess whether the degree of severity of the serious infections differed in the three infection control groups (vaginal misoprostol and no antibiotics; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, to assess whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories. Of particular importance is whether the new infection control measures selectively reduced the least severe serious infections but did not diminish the rate of the most severe infections. METHODS We performed a retrospective analysis assessing the degree of severity of infections before infection controls were implemented and after each of the two new measures was adopted: buccal administration of antibiotics with either screen-and-treat method or routine antibiotic coverage. We ranked the severity of infection from 1 (when treatment occurred in an emergency department) to 4 (when death occurred). We compared the distributions of the severity of serious infections in the three infection control groups (none; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, assessed whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories using the Jonckheere-Terpstra test for a doubly ordered 4 × 3 table. RESULTS The distribution of infection by severity was the same for all three infection control groups. Likewise, when the two new infection control groups--buccal misoprostol plus either screen-and-treat method or routine antibiotics--were combined, the distribution of infection by severity was the same before and after the new measures were implemented. CONCLUSION The pronounced decline in the rate of serious infections occurred in each category of severity.
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Rabiu KA, Adewunmi AA, Akinlusi FM, Akinola OI. Female reproductive tract infections: understandings and care seeking behaviour among women of reproductive age in Lagos, Nigeria. BMC WOMENS HEALTH 2010; 10:8. [PMID: 20331888 PMCID: PMC2851660 DOI: 10.1186/1472-6874-10-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 03/23/2010] [Indexed: 11/25/2022]
Abstract
Background Reproductive tract infections (RTI's) are endemic in developing countries and entail a heavy toll on women. If untreated, RTI's can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of the human immunodeficiency virus. It is also associated with adverse pregnancy outcomes. While RTI's and its sequelae abound in Nigeria, there is paucity of publications on the subject in the country. This study assessed the understandings and care seeking behavior with regards to RTI's among women of reproductive age in Lagos, Nigeria with the aim of improving awareness on the subject. Methods A descriptive cross sectional survey of women attending the gynaecological outpatient and family planning clinics of the Lagos State University Teaching Hospital was carried out between 1st June 2008 and 31st August 2008 using a pre-tested questionnaire. Data was analysed using the Epi-Info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U.S.A. Results Most of the respondents (77.2%) had heard of RTI's. Toilet was the most perceived mode of contracting RTI's (44.6%), followed by sexual intercourse and poor hygiene. Vaginal discharge was the commonest symptom of RTI's named while inability to get pregnant was the commonest named complication. Majority of the respondent's demonstrated poor overall knowledge of symptoms and complications of RTI"s. 37.4% of the respondents had experienced symptoms of RTI's in the preceding six months. Vaginal discharge was the commonest symptom reported (21.8%) and the majority of those who reported symptoms sought medical treatment. Government health centres were the most visited health facilities for treatment. Conclusion Even though most of the respondents have heard of RTI's and sought treatment when symptomatic, they demonstrated poor overall understanding of the subject. There is need to educate women on preventive strategies, as RTI's are often assymptomatic.
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Affiliation(s)
- Kabiru A Rabiu
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria.
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Abstract
Infections in pregnancy and in the postpartum period represent an important knowledge base that emergency physicians should have. Being able to understand the risk that pregnancy-related infections have on maternal and fetal health in addition to the initiation of appropriate treatment for these infections is crucial. In the postpartum period, most infections (94%) are likely to manifest after hospital discharge; therefore, patients frequently present to the emergency department.
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Affiliation(s)
- Diane L Gorgas
- Department of Emergency Medicine, The Ohio State University Medical Center, 164 Means Hall, 1654 Upham Drive, Columbus, OH 43210, USA.
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Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis. Arch Gynecol Obstet 2008; 279:225-7. [PMID: 18506462 DOI: 10.1007/s00404-008-0683-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Accepted: 05/05/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Uterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures. CASE We report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful. DISCUSSION Possible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.
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Ishikawa T, Zhu BL, Li DR, Zhao D, Michiue T, Maeda H. An autopsy case of internal jugular vein thrombophlebitis involving sepsis following blunt neck injury. J Forensic Leg Med 2008; 15:114-7. [PMID: 18206829 DOI: 10.1016/j.jflm.2007.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 04/12/2007] [Indexed: 01/10/2023]
Abstract
We report an unusual case of delayed death due to sepsis following closed blunt injury to the neck. The victim was a 71-year-old male with a clinical history of hypertension, diabetes and gout. He was found dead about three weeks after being assaulted. He had not consulted a hospital after the assault. Forensic autopsy demonstrated a large liquefied subcutaneous hematoma on the right side of the neck, peri- and thrombophlebitis of the right internal jugular vein. Otherwise, there was no evidence of trauma. Histological examination showed dermal vesicles in the skin covering the hematoma, accompanied by marked inflammatory cell infiltration phagocytosing gram-positive streptococci, subcutaneous edema, panphlebitis with partially organized thrombi and bacterial colonies, pulmonary edema and multiple pulmonary microthrombi involving bacterial aggregates. Postmortem serum C-reactive protein and neopterin levels were markedly elevated. These findings suggest sepsis as the cause of death, induced by infected internal jugular vein thrombophlebitis following blunt neck injury involving impaired skin barrier.
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Affiliation(s)
- Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
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Okafor UV, Efetie RE. Critical care management of gynaecological patients in Enugu, Nigeria. Trop Doct 2007; 37:108-9. [PMID: 17540097 DOI: 10.1177/004947550703700219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A retrospective study of the management of gynaecological patients admitted to the general intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, over a 6-year span was carried out. Out of a total of 816 patients admitted to the ICU during the study period, 21 (2.6%) were gynaecological patients with the following diagnoses: generalized sepsis, postoperative respiratory distress, hypovolaemic shock, preoperative anaemia and mennorhagia, and major surgery with potential for major complications. The mortality rate was 28.6% with six deaths, sepsis being the major cause of death (four fatalities).
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Affiliation(s)
- U V Okafor
- University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Abstract
We report the case of a patient who presented with right sciatic pain as a manifestation of piriformis muscle syndrome 1 month after a clandestine- induced abortion. MRI revealed the presence of a piriformis abscess. Staphylococcus aureus was isolated from blood cultures and from the purulent material obtained by CT-guided aspiration. Piriformis pyomyositis should be recognized as a potential complication of "unsafe" abortions that if left untreated could progress to sepsis and death.
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Affiliation(s)
- Ines Colmegna
- Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Wu HH, Yeh GP, Hsieh TC, Lin KC. Fulminant Sepsis after Second-Trimester Amniocentesis in Pregnant Women by in vitro Fertilization and Embryo Transfer. Fetal Diagn Ther 2007; 22:217-20. [PMID: 17228162 DOI: 10.1159/000098721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 05/24/2006] [Indexed: 11/19/2022]
Abstract
Second-trimester amniocentesis is a common procedure for prenatal diagnosis. Sepsis is a rare complication after amniocentesis and may rapidly deteriorate if prompt treatment, including broad-spectrum antibiotics and removal of the infected abortus, is delayed. In vitro fertilization and embryo transfer (IVF-ET) is a standard final treatment for infertile women. Transvaginal oocyte retrieval is necessary for such women; this procedure potentially causes Escherichia coli attaching and effacing in the abdominal cavity. Here we report that two pregnant women by IVF-ET developed sepsis after second-trimester amniocentesis. The cause of sepsis after amniocentesis is still unknown. We provided the possibility of the causation of the E. coli infection associated with the previous intra-abdominal procedure, but it needs more evidence to prove it.
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Affiliation(s)
- Hsin-Hung Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan (ROC).
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Osazuwa H, Aziken M. Septic abortion: a review of social and demographic characteristics. Arch Gynecol Obstet 2006; 275:117-9. [PMID: 16947056 DOI: 10.1007/s00404-006-0233-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2006] [Accepted: 08/04/2006] [Indexed: 10/24/2022]
Abstract
Septic abortion is a significant health problem with short- and long-term complications that affect the quality of life of those fortunate enough to avoid mortality. Both spontaneous and induced abortion can result in septic complications, with the latter disproportionately higher. Its incidence is high in environments with restrictive abortion laws, as clandestine procedures by non-doctors in unhygienic settings are prevalent. This study shows that it is still more common among teenagers and mainly performed by health professionals, which means that health care interventions should be re-evaluated and appropriately directed to preserve the reproductive health status of this vulnerable population.
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Affiliation(s)
- Henry Osazuwa
- Department of Obstetrics and Gynaecology, Igbinedion University Teaching Hospital, Edo State, Nigeria.
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Abstract
We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.
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Affiliation(s)
- Phillip G Stubblefield
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA.
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Finkielman JD, De Feo FD, Heller PG, Afessa B. The clinical course of patients with septic abortion admitted to an intensive care unit. Intensive Care Med 2004; 30:1097-102. [PMID: 15007546 DOI: 10.1007/s00134-004-2207-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Accepted: 01/27/2004] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the clinical course, complications, and outcome of patients with septic abortion admitted to the intensive care unit (ICU). DESIGN, SETTING, AND PATIENTS In this retrospective study, the records of 63 patients with septic abortion admitted to the ICU of a university hospital in Argentina between 1985 and 1995 were reviewed. RESULTS The mean age of the patients was 28.5 years, and 33% had had previous abortions. The mean gestational age was 10.5 weeks. The first ICU day Acute Physiology and Chronic Health Evaluation (APACHE) II mean score was 13.9. Acute renal failure developed in 73% (46 of 63) of the patients, disseminated intravascular coagulation (DIC) in 31% (15 of 49), and septic shock in 32% (20 of 63). Blood cultures were positive in 24% (15 of 62). Twelve patients died (19%). Eight of the deaths occurred during the first 48 h of the ICU admission. Compared with survivors, non-survivors had higher median number of organ failures (1.0 vs 4.0, p<0.0001), mean first ICU day SOFA scores (6.6 vs 10.0, p=0.0059), and mean APACHE II scores (12.7 vs 20.2, p=0.0003), and were more likely to have septic shock (18 vs 92%, p<0.0001), and receive dopamine (37 vs 83%, p=0.0040), mechanical ventilation (8 vs 83%, p<0.0001), and pulmonary artery catheter (8 vs 41%, p=0.0026). CONCLUSIONS Although it is an avoidable complication, septic abortion requiring admission to the ICU is associated with high morbidity and mortality.
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Affiliation(s)
- Javier Daniel Finkielman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Affiliation(s)
- Karl Tamussino
- Department of Obstetrics and Gynecology, University of Graz, Graz, Austria.
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Deziel PJ, McGuire N, Brown PD. Group B streptococcal meningitis complicating elective abortion: report of 2 cases. Clin Infect Dis 2000; 31:E23-5. [PMID: 11073784 DOI: 10.1086/317456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The incidence of invasive disease due to Streptococcus agalactiae (group B streptococcus [GBS]) in adults is on the rise; however, meningitis in adults due to GBS remains rare. We report 2 cases of GBS meningitis complicating elective abortion, 1 of which was a septic incomplete abortion. Only 1 case of bacterial meningitis complicating elective abortion has been reported previously.
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Affiliation(s)
- P J Deziel
- Division of Infectious Diseases, Sinai-Grace Hospital, Detroit, MI 48201, USA
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Ebright JR, Moldenhauer J, Gonik B. Non-surgical management of post-cesarean endomyometritis associated with myometrial gas formation. Infect Dis Obstet Gynecol 2000; 8:181-3. [PMID: 10968603 PMCID: PMC1784680 DOI: 10.1155/s1064744900000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present a case of post-cesarean delivery, nonclostridial endomyometritis in which uterine (myometrial) gas formation raised concern for myonecrosis and need for hysterectomy. The patient fully recovered without surgery. Myometrial gas formation in this setting and in an otherwise stable patient may be an insufficient reason for hysterectomy.
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Affiliation(s)
- J R Ebright
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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Ebright JR, Moldenhauer J, Gonik B. Non-surgical management of post-cesarean endomyometritis associated with myometrial gas formation. Infect Dis Obstet Gynecol 2000. [DOI: 10.1002/1098-0997(2000)8:3/4<181::aid-idog15>3.0.co;2-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cates W, Grimes DA, Hogue LL. Justice Blackmun and legal abortion--a besieged legacy to women's reproductive health. Am J Public Health 1995; 85:1204-6. [PMID: 7661225 PMCID: PMC1615595 DOI: 10.2105/ajph.85.9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- W Cates
- Family Health International, Research Triangle Park, NC, USA
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