Septic abortion
Contents:
Description:
In the fever (septic) abortion - one of the heaviest complications of abortion developing preferential in extra hospital conditions at persons with primary and secondary (owing to pregnancy) an immunodeficiency.
Symptoms of Septic abortion:
Symptoms of septic abortion it is characterized by a pan-metritis, acute sepsis, septic (bakteriotoksichesky) shock, acute renal insufficiency, peritonitis. Intervention quite often is complicated by an injury (a uterus perforation at abortion) and bleeding. Complaints by a call of ambulance - a hyperthermia, oznoba, perspiration, the general weakness, tachycardia, pain and heavy feeling in the bottom of a stomach, a meteorism, an oliguria, bloody purulent discharges from a genital tract. Usually the amenorrhea or the fact of intervention for abortion are not suppressed. Sometimes the aggravation of symptoms is connected with an injury (household, production, road and transport and so forth). Some women do not know about the pregnancy. The general serious condition of the patient, pallor, grayish-yellow skin color and mucous membranes, a xeroderma and language, frequent soft pulse, symptoms of muscular protection and peritoneal symptoms attract attention. Typrop of skin is lowered, the positive symptom of "a white spot" is noted.
Reasons of Septic abortion:
Releasers are intervention in the kontaminirovanny environment (a vagina and a uterus) and superinfection antibiotikorezistentny microflora.
Treatment of Septic abortion:
Maintaining patients decides on septic abortion by weight of spread of an infection. Allocate 3 stages of spread of an infection: I - the endometria and a myometrium, II - in addition to a uterus are involved in process, appendages, III - generalized peritonitis and sepsis are involved in process.
The forecast of septic abortion depends on degree of manifestation of fever, hypotension, an oliguria, existence of an infection outside a uterus and duration of gestation (the it is more, the forecast is worse).
When maintaining patients monitor control of the vital functions and a diuresis are necessary. Make blood test with definition of number of thrombocytes, level of electrolytes, blood proteins, creatinine, a gemostaziogramma. The hematocrit has to be not less than 30-35%.
Carry out intensive and complex treatment, apply antibiotics of a broad spectrum of activity (the antibacterial, disintoxication, desensibilizing, immunocorrective therapy).
Depending on a condition of the patient and severity of an infection make operative measures from a curettage to a hysterectomy.
Now it is established that septic abortion is always the indication to surgical treatment as, first of all, the infection source has to be removed.
At duration of gestation to 12 weeks carefully expand a neck of uterus (if it is not opened) and by means of the curette or a vacuum aspirator delete uterus contents. To be sure of full emptying of a uterus, it is reasonable to make operation under control either ultrasonography, or hysteroscopies. After tool removal of fetal egg or its remains it is necessary to wash out a uterus of 1% dioxidin solution under small pressure.
All surgeries at septic abortion are performed by the experienced doctor (danger of perforation of a wall of a uterus at abortion!
At pregnancy over 12 weeks a fruit from a uterus are deleted by introduction of uterotonichesky means (oxytocin, F2a prostaglandin).
The heaviest complication of septic abortion is septic shock which main symptoms are the oliguria, hypotension, a tachypnea, consciousness disturbance, cyanosis of skin of extremities; a renal failure and the disseminated intravascular coagulopathy.
