Clinical features: Interruption of pregnancy (expulsion of a fetus) before it is viable, legally at 28th week of gestation. Clinical types are recognized according to findings when the patient is first seen. These include: threatened abortion, inevitable abortion, incomplete abortion, complete abortion and missed abortion. Vaginal bleeding which may be very heavy in incomplete abortion, intermittent pain which ceases when abortion is complete, and cervical dilatation in inevitable abortion. In missed abortion, dead ovum retained for several weeks while symptoms and signs of pregnancy disappear. When infected (septic abortion) patient presents with fever tachycardia, offensive vaginal discharge, pelvic and abdominal pain.
Post Abortal Sepsis
Pyrexia in a women who has delivered or miscarried in the previous 6 weeks may be due to puerperal or abortal sepsis and should be managed actively. Abdominal pain in addition to pyrexia is strongly suggestive. The uterus may need evacuation.
Mild/moderate
Drug of choice
Amoxycillin (O) 500 mg every 8 hours for 10 days
Plus
Metronidazole (O) 400-500 mg every 8 hours for 10 days
Plus
Doxycycline (O) 200 mg stat, then 100 mg daily for 10 days.
Treatment Guidelines for severe cases
Body temperature higher than (38°C)
Marked abdominal tenderness are signs of severe post abortal sepsis
Drug of Choice
Benzylpenicillin (IV) 2 MU every 6 hours
Add
Chloramphenicol (IV) 500 mg every 6 hours
Add
Metronidazole (O) 1 g twice daily
NOTE If patient cannot swallow give Metronidazole (PR) 1 gm twice daily or IV/500 mg every 8 hours |
Second Choice
Ampicillin (IV) 500 mg every 6 hours
Add
Gentamicin (IM) 80 mg every 8 hours
Add
Metronidazole (O) or (PR) 1 g twice daily.
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NOTE
- Change to oral therapy if temperature rise is controlled
- Pelvic abscess may be suspected if after 48 hours no response, in this case laparotomy or referral may be necessary
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