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Treating Spontaneous and Induced Septic Abortions

Eschenbach, David A., MD

doi: 10.1097/AOG.0000000000000795
Contents: Clinical Expert Series
Expert Discussion
Spanish Translation

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.

Effective treatment of septic abortion begins with the prompt removal of infected tissue.

Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.

Corresponding author: David A. Eschenbach, MD, Department of Obstetrics and Gynecology, Box 356460, University of Washington, Seattle, WA 98195; e-mail: eschen@uw.edu.

Continuing medical education for this article is available at http://links.lww.com/AOG/A625.

Financial Disclosure The author did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.