SEPTIC

ABORTION
BY
DR. JAMES E. OMIETIMI
 INTRODUCTION
 More than 60% of pregnancies end in
spontaneous abortion.
 Most pregnancies are lost in the early
weeks of pregnancy than at any other
stage of gestation, with 80% of
spontaneous abortions occurring prior to
12 weeks gestation.
 The WHO estimates that about 46 million
cases of abortion occur annually
 About 90-95% of this figure occurs in the
developing countries and more than 80%
of these are unsafe abortions, often
 DEFINITION
 Abortion is the termination of
pregnancy before fetal viability,
usually taken in our environment to
be the 28th week of gestation.

OR
By the W.H.O.
The expulsion or extraction of the
embryo or
 EPIDEMIOLOGY
It is virtually impossible to state an accurate
frequency of spontaneous abortions, because
some of the early cases are not definitely
diagnosed and may be regarded as abnormal
menstrual period.
The incidence of spontaneous abortions is
generally estimated to be 15-17 % of all
pregnancies. 5 per 1000 women in Holland.
The incidence in Nigeria is about 610,000 P.A.,
accounting for 40% of the cases in W.A., 25 per
1000 women aged 15-45years.
Commonest gynaecologic admission in U.P.T.H.
accounting for (27%) 137 out of 502. (2003
 AETIOPATHOLOGY
 The aetiology is unknown in majority of cases.
 Most 1st trimester abortions are due to an
abnormal karyotype while later abortions are
due to chromosomal abnormalities and
maternal factors.
 Aneuploidy- (an abnormal chromosome
number) 50% of cases
 Autosomal trisomies- all chromosomes, except
1, with trisomy 16, being the most common.
 Monosomy X or Turner’s syndrome is the
commonest aneuploidy in spontaneous
abortions- 20% of all.
 Polyploidy in the form of triploidy accounts for
20%. They typically result in blighted ovums or
 Aetiopathology Continued.
Maternal infections/infestations
UTI, Malaria, Pyelonephritis, Appendicitis,
Listeria monocytogenes.
Trepanoma pallidum
TORCH organisms.
Maternal Diseases;
Diabetes Mellitus
Hypertensive Diseases
Renal diseases
Systemic lupus erythromatosis
Hypothyroidism
Hyperthyroidism
Wilson Disease
 Aetiopathology
continued
UTERINE DEFECTS;
unicornuate, bicornuate, septate uteri.
Diethlstilbesterol (DES)-related anomaly such as
T-shaped or hypoplastic uteri
Acquired anomalies-uterine fibroids, Asherman’s
syndrome
Cervical Incompetence
MALNUTRITION; Severe malnutrition
TRAUMA; Direct trauma such as injury to the
uterus e.g.
Gunshot injury or
Indirect trauma such as surgical
removal of an ovary containing a
 AETIOPATHOLOGY
 Continued
IMMUNOLOGIC DISORDERS;
ABO, Rh, Kell etc
Similar maternal and paternal HLA may enhance
the possibility of abortion by causing
insufficient maternal immunologic recognition
of the fetus.
TOXIC FACTORS;
Radiation
Anti-neoplastic agents
Anaesthetic agents
Alcohol
Nicotine
Lead
Ethylene oxide
 CLINICAL VARIETIES OF
ABORTION
THREATENED ABORTION;
At least 20% of pregnant women have some
first trimester bleeding.
Usually thought to be implantation bleed
The cevical os is usually closed
There is no associated painful uterine
contraction
INEVITABLE ABORTION;
Increased vaginal bleeding
Associated with painful uterine contractions,
lower abdominal or back pain
There is cervical effacement and dilatation
INCOMPLETE ABORTION;
The products of conception have been
partially passed from the uterine
cavity
Usually associated with abdominal
cramps
When infected leads to septic
abortion.
Bleeding is generally persistent and if
severe may lead to shock.
COMPLETE ABORTION;
All the products of conception have
 MISSED ABORTION
The embryo dies but the gestational sac
and embryo are retained in the uterus for
several weeks or months.
Symptoms and signs of pregnancy
disappear.
Immunological tests for pregnancy usually
become negative about 10 days after the
death of the embryo
Disseminated Intravascular Coagulation
 SEPTIC ABORTION
 Presence of an intrauterine infection following
an abortion;
 1. This may be due to infected retained
products of conception.
 2. Use of non sterile instruments to procure
abortion
 3. Uterine perforation with spillage of intestinal
contents.
 ORGANISMS;
E.coli, streptococci, staph. Aureus, proteus,
pseudomonas, pneumococci, klebsiella,
Chlamydia trachomatis, Neisseria gonorrhoea,
 CLINICAL PRESENTATION
HISTORY:
Hx. of an abortion may or may not be
volunteered
There is usually high grade fever
Generalized, Suprapubic, lower abdominal
or low back pain
Offensive vaginal discharge
EXAMINATION:
General-Pale, febrile, jaundiced, furred
tongue, offensive CVS-
tachycardia and hypotension
Abdomen- guarding, tenderness;
 EXAMINATION continued.
 V/E: There may or may not be bruises on
vulva
Vagina is usually hot
Cervical Os may be open or closed
Uterus and adnaexae are usually
tender Pouch of Douglas may
be full and tender Cervical
motion tenderness is usually positive
Gloved examining fingers are
usually stained with offensive
 COMPLICATIONS
 Immediate;
Anaemia from haemorrhage
Endotoxic shock
Acute renal failure
Death
Long Term;
Chronic PID
Chronic tubo-ovarian masses/abscesses
Chronic vaginal discharge
Chronic pelvic pain
Dyspareunia
Tubal occlusion with secondary Infertility
Ectopic pregnancy
Asherman’s syndrome
Adhesions with intestinal obstruction