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SEPTIC ABORTION:

Suspected septic abortion with RPOC is a medical emergency, and management should be immediate. The uterus should be evacuated promptly after initiating antibiotics and stabilizing the patient in cases of suspected septic abortion or RPOC as delay may be fatal. Suction curettage is less traumatic than sharp curettage. If the patient fails to respond to uterine evacuation and  antibiotics, a pelvic abscess or clostridial necrotizing myonecrosis, although rare, should be suspected. In such case, laparotomy and possible hysterectomy might be considered.

                            
                                                       fig 1.1 SEPTIC ABORTION

Abortion with septic shock

Abortion with septic shock is a medical emergency. An abortion is a procedure that ends a pregnancy. Septic shock occurs when an infection overtakes your body and causes very low blood pressure.

Septic shock can affect anyone susceptible to the germs that cause infection. When linked with abortion, septic shock can be a dangerous complication.

Types of abortions

There are several types of abortions:

A spontaneous abortion (miscarriage) occurs when pregnancy tissue is passed from the body. There are technically two types of spontaneous abortions: “complete,” in which all the pregnancy tissue is passed and no intervention is needed, and “incomplete,” in which only part of the pregnancy tissue is passed and it usually does require intervention.

A surgical abortion is the removal of the fetus and placenta from the woman’s uterus. The doctor typically uses a vacuum to extract the pregnancy material.

      fig 1.2 SEPTIC ABORTION

A medical abortion uses prescribed medications. These medications help the mother pass the fetus and related tissue. The result is similar to a miscarriage.

A self-induced abortion is done by the mother herself. This term includes both abortions conducted through legal, over-the-counter medication and those performed through unregulated, often dangerous methods.

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Symptoms of abortion with septic shock

Symptoms

Septic shock is a medical emergency. If you recently had an abortion and experience any of the following symptoms, seek medical help immediately:

     fig 1.3 Symptoms of abortion with septic shock

• Very high or very low body temperature
• Heavy bleeding
• Severe pain
• Cool, pale arms and legs
• Feelings of confusion, restlessness, or fatigue
• Shaking chills
• Low blood pressure, especially when standing
• Inability to urinate
• Heart palpitations
• Rapid, pounding heart rate
• Difficult, rapid breathing with shortness of breath

Causes of abortion with septic shock

Causes

Septic shock often occurs after the abortion procedure is completed. It strikes when your body becomes contaminated with a bacterial infection.

In most cases, the infection stays in a specific area. However, in more severe cases, the infection enters your bloodstream and travels throughout your body. This is called a systemic reaction. The resulting condition is called sepsis.

fig 1.4 Abortion of septic shock

Your body’s initial reaction to sepsis typically involves very low or very high body temperatures. In addition, sepsis causes:

• Rapid heart rate
• Rapid breathing rate
• Very high or very low white blood cell count
• As sepsis weakens your body’s immune responses, your organs begin to fail. When sepsis worsens so that your blood pressure drops dangerously low and is immune to treatment, the condition is called septic shock.

In abortions, two main factors can contribute to the onset of sepsis and ultimately, septic shock. They are:

An incomplete abortion: pieces of the pregnancy tissue remain in the body after a spontaneous or induced abortion, both medical and surgical

bacterial infection in the uterus during a surgical or self-induced abortion

                                     
                                                   fig 1.5 Abortion of Septic Shock

Risk factors for abortion with septic shock

Risk Factors

Your risk for septic shock is increased in situations where bacteria are more likely to enter your bloodstream. Having any surgery or medical procedure puts you at an increased risk for septic shock.

When medical devices are inserted into your body, the device can introduce bacteria. This makes infection and sepsis more likely. The longer the device is in your body, the higher your risk for infection.

In a surgical abortion, the doctor uses a vacuum with a hollow tube to remove the fetus and placenta from the womb. Medical devices, such as catheters, drainage tubes, or breathing tubes can put you at a similar risk of infection.

                             

                        

                                                       fig 1.6 Abortion of septic shock

The risk for septic shock is significantly increased in self-induced abortion, where medical instruments are not used. There is less ability to prevent germs from spreading because many of the common tools are everyday household items and are not sterile.

In addition, having certain underlying conditions prior to an abortion can make you more susceptible to septic shock. They include having a chronic condition such as diabetes or a weakened immune system.

Most medical abortion regimens recommend a follow-up ultrasound after the abortion has occurred. This examination can help determine if any of the pregnancy materials remain.

• Complications of abortion with septic shock
• Complications
• If not treated promptly, septic shock can be fatal. It can cause organ failure and damage virtually any part of your body.

Typical complications include:

• Respiratory failure
• Cardiac failure
• Liver failure
• Kidney failure
• Gangrene (body tissues die due to loss of blood)

In cases where septic shock is caused by a septic abortion, a total hysterectomy may be necessary to remove the source of the infection. A total hysterectomy removes the uterus, cervix, fallopian tubes, and both ovaries.

                                 
                                              fig 1.7 Complication of septic shock

         

Diagnosis of abortion with septic shock

Diagnosis

A diagnosis of septic shock can be confirmed with laboratory tests:

A blood test can identify bacteria in the bloodstream. Your white blood count, blood oxygen level, and organ functions will also be checked.

Samples from your urine, cerebrospinal fluid, and lung mucus will be cultured and tested for bacteria. Tissue samples from wounds may be tested.

CT scans may be performed to identify residual pregnancy matter, obstructions, perforations, or foreign bodies.

A chest X-ray may be done to check for fluid in your lungs or pneumonia.

An electrocardiogram (ECG or EKG) may be done to identify abnormal heart rhythms. An EKG monitors your heart rate. Electrodes are taped to your chest to send the sound of your heart to the monitor. This can help determine whether the heart’s blood supply is affected.

                                           
                                                              fig 1.8  Diagnosis abortion

Treatment and recovery

Treatment

Septic shock is a medical emergency that must be treated immediately. Because of the urgency, treatment often begins before the test results can confirm the diagnosis. If you have signs of septic shock after an abortion, you must be admitted immediately to an intensive care unit.

Successful treatment for septic shock is centered on two goals: protection of the vital organs and removal of the source of the infection.

fig 1.9 Abortion Treatment and Recovery

Antibiotics are given first. Test results identifying the specific bacteria that are causing sepsis can take a few days. To improve the chances of killing the bacteria, two or three antibiotics may be combined. 

Typical antibiotic treatment involves a combination of:

• Ampicillin
• Gentamicin
• Clindamycin or metronidazole

The treatment can be refined once the specific bacteria are identified. Your chances of surviving septic shock increase when you receive antibiotics soon after the abortion.

Your treatment may include:

• Mechanical ventilation (breathing machine)
• Medication (to increase blood pressure)
• Intravenous (IV) fluids (to increase fluid in the bloodstream and blood pressure)
• Oxygen
• Hemodynamic monitoring (evaluation of heart and lung pressure levels)

In some cases, surgery is necessary. A complete hysterectomy may be performed if the infection is caused by matter from an abortion.

In some cases, a laparotomy may be performed. A laparotomy is an incision in the abdominal wall that allows for quick access to the abdominal cavity. This may be needed if your physician suspects the infection is caused by:

• Uterine perforation
• Bowel injury
• Abscess
• Soft tissue infection
• Prognosis
• Outlook
• Septic shock, regardless of the source, has a high mortality (death) rate. Specific Circumstances can affect successful treatment. These include:
• Age
• Overall health
• Degree of organ failure
• Timing of the start of medical treatment

How to prevent septic shock

Prevention

Many cases of septic shock can’t be anticipated or prevented. You can reduce your risk by following these precautions:

• Consult with a licensed physician or clinic to pursue an elective abortion.
• Follow the directions exactly as provided for a medical abortion.
• Never attempt a self-induced abortion.
• Be aware of the signs of bacterial infection after any type of abortion.
• Pursue treatment for an infection as soon as possible.

Guide how to cure the threatened abortion during pregnancy

POISONING IN PREGNANCY RISK FACTORS

Pregnancylosses may be related to the host environment. Congenital or acquired cervical and uterine abnormalities, infections, maternal endocrinopathies and a hypercoagulable state are some factors that have been implicated in the occurrence of spontaneous abortion.

   1)    Congenital or acquired uterine abnormalities can interfere with implantation and growth. In a recent review of the literature regarding fibroids and their effect on reproductive performance, the authors suggested that the best available evidence indicates that sub mucous myomas decrease fertility and increase the spontaneous abortion rate. Myomectomy is likely to be of value. This may be true for intramural myomas as well.

    2)    Acute maternal infection could lead to abortion due to fetal or placental involvement. Infections are an accepted cause of late fetal demise; therefore, it is logical that they are responsible for early fetal losses as well. A large number of organisms have been reported to be associated with spontaneous abortions including, among others, Listeria monocytogenes, Parvovirus B19, Rubella, Herpes simplex, Toxoplasma gondii, Mycoplasma hominis, Chlamydia trachomatis, and Urea plasma urealyticum. However, evidence of this relation has not been extensively conformed.

    3)    Maternal endocrinopathies such as poorly controlled diabetes mellitus and thyroid dysfunction can contribute to a sub-optimal host environment. Luteal phase defect is another condition that has been suggested to be associated with spontaneous miscarriage. A successful pregnancy is dependent on sufficient progesterone support. Before the placenta takes over progesterone production, the progesterone production by the corpus luteum provides the necessary support of early pregnancy. A defect in corpus luteum function is associated not only with implantation failure but with miscarriage. However,the association between corpus luteum defects and miscarriage is controversial.

    4)    Hypercoagulable state due to inherited or acquired thrombophilia and abnormalities of the immune system may lead to immunological rejection or placental damage and are accepted causes of miscarriage.

   5)    Additional factors that are considered possible causes of spontaneous abortion include      trauma; alloimmune disease; exposure to drugs, substance use, and environmental   contaminants; some maternal illnesses; and psychological factors.

When the etiology of abortion in chromosomally and structurally normal embryos of women that are apparently healthy remains unclear, it is considered unexplained.

 When the etiology of abortion in chromosomally and structurally normal embryos of women that are apparently healthy remains unclear, it is considered unexplained.

Pregnancy and food poisoning

Food poisoning is an unpleasant experience but most people recover without any ill effects. But there are particular risks for pregnant women. These range from dehydration caused by vomiting and/or diarrhoea through to birth defects and miscarriage.

The main risk is that of damage to the unborn baby caused by bacteria which are responsible for food poisoning. The worst case scenario is premature birth, stillbirth or miscarriage.

What causes food poisoning

Bacteria, viruses or parasites cause food poisoning but there are a few which are particularly problematic for pregnant women. These include e coli, salmonella, campylobacter and listeria.

These can all spread to the unborn baby via the placenta where they will cause a range of health problems at birth which include meningitis. In some cases they may lead to a stillbirth.

But the worst is listeria. This is one type of bacteria which pregnant women need to be aware of as it is can cause both the mother and baby to become seriously ill. It is also responsible for a series of complications which can result in long term health problems in the baby. These can range from plain nasty through to fatal.

The effect of food poisoning on your pregnancy

If you are pregnant and you develop food poisoning then in most cases, it will not cause any long term problems for both you and your baby; however, you can expect it to be more unpleasant than usual due to the fact that your body is already under pressure as a result of your pregnancy.

So, look at reducing your risk of food poisoning as much as possible. That means taking notice of food safety and hygiene and being careful about the types of foods that you eat. Avoid those foods which are a known risk for listeria.

Basically, the healthier you are the better that is for your unborn baby.

The issue here is that the effects of food poisoning are more likely to cause problems for your unborn baby than for you. Your unborn baby is a greater risk due to it having an underdeveloped immune system which makes it vulnerable to all types of infections. This includes bacterial food poisoning.

Find out more in our preventing food poisoning section.

Listeria and pregnancy

Listeria food poisoning or listeriosis is caused by the consumption of foods which contain these bacteria. Examples of these include soft cheese such as Camembert or Brie; blue cheese; butter, pates; cooked meats such as ham or salami; and ready meals which are found in the chiller cabinet in supermarkets.

Unwashed fruit, vegetables and salads are also a factor as is unpasteurised milk. Undercooked meat and fish are also a danger.

If you are pregnant then you will have been advised to avoid these foods due to these risks. Choose hard cheeses such as Cheddar, pasteurised milk, yoghurts and cottage cheese. Make sure that you wash all salads, fruit and vegetables before you eat them.

Pregnant women are at greater risk of listeriosis which may be due to a lowering of their immunity plus changes to their metabolism. A weakened immune system is one of the risk factors for food poisoning and other illnesses as it is less able to fight the bacteria which cause these.

If you eat food which has been contaminated by the listeria bacteria then these will pass into your intestine via digestion. Once there they release toxins into the lining of the intestine which results in an infection.

This infection causes symptoms such as nausea, stomach pains, vomiting and diarrhoea.

Complications include blood poisoning (septicaemia), confusion, seizures and stillbirth or miscarriage in pregnant women.

Listeria and the unborn baby

If a pregnant women contracts listeriosis in the 14th week or onwards of her pregnancy then this is likely to affect the health of the baby. This can only be detected via a blood test or an ultrasound scan.

Unfortunately, babies can become infected with listeriosis during birth if the bacteria are present within the mother’s vagina. These symptoms may not be apparent at birth but can develop later on. These can cause:

Jaundice

Pneumonia

Meningitis

What also needs to be taken into account is that any infection, even if it is relatively mild, will deprive the unborn baby of essential nutrients which are vital for its development.

One example of this is toxoplasmosis which is spread via contact with infected cats (or their litter). If this spreads to the unborn baby then it is likely to cause birth defects or even a miscarriage.

This is why it is advisable for pregnant women to avoid any contact with cat litter or an infected animal during their pregnancy.

Treatment for food poisoning during pregnancy

If you are pregnant and suspect that you developed food poisoning then ask your midwife or GP for advice. Do this if you think your illness is caused by listeria bacteria as these can be dangerous during pregnancy.

Your GP is required by law to notify the authorities about any case of food poisoning.

You will need to rest during this time, drink plenty of fluids and take an oral re-hydration powder if necessary. This powder contains electrolytes which are vitamins, minerals and sugars, essential for the everyday functioning of the body.

These powders are available as sachets from your local chemist.

Your GP will perform a blood test and if this shows that you have bacterial food poisoning then you will be prescribed antibiotics to treat this. He or she will check that these are safe for you to take during your pregnancy.

Preventing food poisoning during pregnancy

There are a few steps you can take to reduce your risk of food poisoning. These include only eating foods which are safe to eat during pregnancy; washing your hands every time you handle food; checking that food is cooked properly and using food before its ‘use by’date.

POISONING IN PREGNANCY : AWARE SPONTANEOUS ABORTIONS AFTER GET PREGNANT

POISONING IN PREGNANCY : AWARE SPONTANEOUS ABORTIONS AFTER GET PREGNANT: There are various stages and types of spontaneous abortions FIG 1.1. spontaneous abortion                              ...

AWARE SPONTANEOUS ABORTIONS AFTER GET PREGNANT

There are various stages and types of spontaneous abortions

FIG 1.1. spontaneous abortion

                                                     

1)            Spontaneous abortion/miscarriage: A pregnancy that can be  ends with the  spontaneously before the fetus that has reached a viable gestational age.

2)            Threatened abortion: Bleeding through a closed cervical os during the first half of pregnancy. The bleeding is often painless, although it may be accompanied by mild suprapubic pain. On examination, the uterine that has the size is appropriate and also for gestational age, and the cervix is long and closed. Fetal cardiac activity can be detectable if the gestation is sufficiently advanced.

3)            Inevitable abortion: When abortion is pending, there may be increased bleeding intensely painful uterine cramps, and a dilated cervix . The gestational tissue can  be often  to be felt or by the visualized through which the internal cervical operating systems.

4)            Incomplete abortion: When the fetus is passed, but significant amounts of placental tissue may be retained, also called an abortion with retained products of conception. On examination the cervical os is open, gestational tissue may be observed in the vaginal/cervix, and the uterus is smaller than expected for gestational age but not well contracted. The amount of bleeding varies but can be severe enough to cause hypovolemic shock. Painful that cramps that are to be often present.

FIG 1.2. spontaneous abortion

5)            Complete abortion: When an abortion occurs and the entire contents of the uterus are expelled. More than one-third of all cases are complete abortions. If a complete abortion has occurred, the uterus is small and well contracted with a closed cervix; slight vaginal bleeding and mild cramping can be present.

6)            Missed abortion: Refers to in utero death of the embryo or fetus prior to the 20th week of gestation, with prolonged retention of the pregnancy. Vaginal bleeding that may be used may be used to occur, and the cervix is usually closed.

                                     

                                                              FIG.1.a. infertility

7)            Septicabortion: An abortion accompanied by fever, chills, malaise, abdominal pain, vaginal bleeding, and frequently purulent discharge. Physical examination that may reveal tachycardia, tachypnea, lower abdominal tenderness, and a tender uterus with dilated cervix. Infection is usually due to staphylococcus aureus, Gram-negative bacilli, or some Gram-positive cocci. Mixed infections can also be encountered. The infection may spread, leading to salpingitis, generalized peritonitis, and septicaemia.

FIG 1.3. Abortion due to miscarriage

A miscarriage refers to the loss of a pregnancy and is estimated to occur in 15 to 20 percent of all pregnancies. Most miscarriages occur during the first 13 weeks of pregnancy, though they can occur later on in the pregnancy.

FIG 1.4.Miscarriage abortion

Understanding Different Stages of Miscarriage

                                

                                                 FIG.1.b. miscarriage infertility

                                                

There are different kinds of miscarriages that can occur at different stages of your pregnancy. Depending on the type of miscarriage, different signs may be noticeable, and different treatments may be necessary.

FIG 1.5.stages of miscariages

Chemical Pregnancy

A chemical pregnancy is a very early miscarriage which can occur before a woman even learns that she is pregnant. With chemical pregnancy, an egg is fertilized, but dies shortly after implantation, so a heartbeat is never identified. Recently, more chemical pregnancies have been diagnosed as a result of pregnancy tests that allow earlier results.

FIG 1.6.chemical pregnancy

Most chemical pregnancies result from chromosomal abnormalities in the fertilized egg. There may be no signs of a chemical pregnancy. Most women simply begin to bleed around the time of their next period, though their period may arrive a few days late or be slightly heavier.

FIG 1.7. pregnancy normal levels

Blighted Ovum

Also known as anembryonic pregnancy, blighted  ovum  occurs very early in pregnancy, often before a woman even knows that she is pregnant. Blighted ovum occurs when a fertilized egg attached to the uterine wall, but an embryo does not develop. Women may feel signs of pregnancy, 



                                   
                                               FIG.1.1.a. Attitude success of infertility


but when a doctor performs an ultrasound, he or she notices an empty gestational sac or cannot confirm a heartbeat. After a blighted ovum, women can miscarry the pregnancy or schedule a dilation and curettage (D&C) procedure, in which the woman’s cervix is opened and her uterus scraped.

FIG 1.7.Blighted ovum

Missed Miscarriage

With a missed miscarriage, a fetus dies early in pregnancy, but the pregnancy tissue is not expelled by the woman’s body. A woman who has experienced a missed miscarriage, also called a missed abortion, may continue to feel signs of pregnancy if the placenta still releases hormones, or she may notice signs of pregnancy fade. Some women may experience some vaginal discharge and cramping, but many have no symptoms of miscarriage. Sometimes the body will dispel the fetal tissue, but other times, a D&C procedure is necessary.

FIG 1.8. missed miscarriage 

Threatened Miscarriage

A threatened miscarriage refers to vaginal bleeding that occurs during the first 20 weeks of pregnancy. Other symptoms of threatened miscarriage include lower back pain and abdominal cramps. Threatened miscarriages do not necessarily mean your pregnancy will end in a miscarriage.

FIG 1.9. Threatened miscarriage

If you have experienced unexplained bleeding during pregnancy, your doctor will want to perform an examination. In a threatened miscarriage, the cervix will remain closed. However, if an examination reveals the cervix has opened, a miscarriage is much more likely. Threatened miscarriages can be frightening, but it is important to note that around half of threatened miscarriages result in a live birth.

                               

                                       FIG.1.c. Attitude success of infertility

Inevitable Miscarriage

Inevitable miscarriage refers to unexplained vaginal bleeding and abdominal pain during early pregnancy. Unlike threatened miscarriage, an inevitable miscarriage is also accompanied by dilation of the cervical canal. Bleeding is also heavier and  abdominal cramps  more severe in an inevitable miscarriage. The open cervix in an inevitable miscarriage is a sign that the body is in the process of miscarrying the pregnancy.

FIG 1.10.inevitable miscarriage

Incomplete Abortion

An incomplete abortion is often accompanied by heavy vaginal bleeding and intense abdominal pain. An incomplete abortion, which is also called an incomplete miscarriage, is also characterized by an open cervix and the passage of the pregnancy. Patients may pass some of the pregnancy tissue, or an examination may observe evidence of tissue passage. All the products of conception have not been passed, and an ultrasound may still detect some tissue in the uterus.

                      FIG 1.11.incomplete abortion

Complete Miscarriage

A complete miscarriage refers to a miscarriage in which all of the pregnancy tissue is expelled from the uterus. A complete miscarriage, which is also called a complete abortion, is characterized by heavy vaginal bleeding, severe abdominal pain, and passage of pregnancy tissue. With a complete miscarriage, the bleeding and pain should subside quickly. Complete miscarriages can be confirmed through an ultrasound.

                                                   FIG 1.12 complete miscarriage

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