Infected Abortion - Septic Abortion

Overview, Causes, & Risk Factors

A septic abortion is an abortion associated with an infection inside a pregnant woman's uterus. An abortion is the expulsion of fetal contents from a woman's uterus. An abortion may be spontaneous, which is referred to as a miscarriage. It may also be an elective surgical or medical abortion, meaning the woman chose to terminate her pregnancy.

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 fetus. 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 disease (STD) such as Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. ',CAPTION,'Chlamydia');" onmouseout="return nd();">chlamydia, the bacteria causing the STD can infect the uterus.

The infection can spread through the fetal tissue 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 causes and risks of the condition?

A septic abortion may be caused by any of the following factors:

  • the membranes surrounding the fetus have ruptured, sometimes without being detected
  • the woman has a sexually transmitted disease, such as Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. ',CAPTION,'Chlamydia');" onmouseout="return nd();"> chlamydia
  • an intrauterine device (IUD) was left in place during the pregnancy
  • tissue from the fetus or placenta is left inside the uterus after a miscarriage or abortion
  • attempts were made to end the pregnancy, often illegally, by inserting tools, chemicals, or soaps into the uterus

    • Symptoms & Signs

    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 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 isn't treated quickly and effectively, the woman may die.

    Diagnosis & Tests

    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.

    The provider may order diagnostic tests, including the following:

  • a CBC, or complete blood count, to look for signs of infection
  • a pregnancy ultrasound, which may show fetal tissue, a dead fetus, or an empty sac in the uterus
  • cultures of blood or uterine contents, to check for the presence of bacteria that cause an infection

    • Prevention & Expectations

    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 diseases in the first trimester of her pregnancy. If a woman thinks she might be miscarrying or has miscarried, she should call her healthcare provider right away.

    It may be too late to save the pregnancy, but good follow-up care can prevent an infection.

    What are the long-term effects of the condition?

    Shock may lead to kidney failure, general bleeding, and clotting problems that can be hard to control. A septic abortion can cause death if it is not treated promptly and effectively.

    If the infection spreads to the abdomen, intestinal organs may also become infected. That can cause scar tissue leading to chronic pain, intestinal blockage, and infertility.

    What are the risks to others?

    A septic abortion is not contagious and poses no risk to others. However, the abortion itself causes the death of the fetus.

    Treatment & Monitoring

    What are the treatments for the condition?

    Immediate and aggressive treatment in a hospital is necessary to avoid serious complications of septic abortion. The woman should have intravenous (IV) fluids to maintain blood pressure and urine output. IV antibiotics will be given to cover a range of bacteria until the fever is gone. A dilatation and curettage (D & C) may be needed to clean out the uterus if fetal tissue has remained inside it.

    A woman with Rh negative blood will be given an injection of Rh immune globulin, unless the father is also known to have Rh negative blood. In cases so severe that abscesses have formed in the ovaries and tubes, it may be necessary to remove the uterus and the infected organs.

    What are the side effects of the treatments?

    Antibiotics may cause rash, upset stomach, or allergic reaction. Surgery can cause bleeding, further infection, or allergic reaction to anesthesia.

    What happens after treatment for the condition?

    Following a septic abortion, a woman may be tired for several weeks. Taking vitamins with iron once a day will help. She should not have intercourse or use tampons until recommended by the healthcare provider.

    If another pregnancy is desired, a couple should wait three to six months after treatment is successfully completed to try to conceive. If they are not successful within a year, a test may done to see if the fallopian tubes were damaged by the infection. A woman should be alert to signs of depression. If she does become depressed, counseling or antidepressant medications can help.

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.

    Attribution

    Author:Eva Martin, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:02/28/01
    Reviewer:Barbara Mallari, RN, BSN, PHN
    Date Reviewed:07/27/01