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Postabortion Intrauterine Infection (Septic Abortion)

Endometritis and pelvic sepsis after pregnancy termination or miscarriage

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Postabortion Intrauterine Infection (Septic Abortion)?

Septic abortion involves microbial invasion of the uterine cavity and endometrium following abortion or miscarriage, often associated with retained products of conception.

It is more common after unsafe or self-induced abortion but can occur after legal induced abortion or spontaneous miscarriage.

Pathogens are typically polymicrobial: vaginal flora ascending into the uterus, including streptococci, staphylococci, anaerobes, gram-negative rods and Mycoplasma.

Severe forms include Clostridium perfringens infection causing toxic shock and hemolysis, and group A streptococcus causing rapidly progressive necrotizing infection.

Untreated, infection can progress to pelvic abscess, peritonitis, septic shock, disseminated intravascular coagulation and death.

Symptoms

Fever above 38 degrees, chills and rigors
Lower abdominal or pelvic pain
Foul-smelling vaginal discharge
Vaginal bleeding, sometimes heavy
Uterine tenderness and cervical motion tenderness on examination
Tachycardia, hypotension, signs of sepsis
Nausea, vomiting, lethargy
Severe disease: dark urine, jaundice (Clostridium hemolysis), confusion, oliguria, septic shock

Risk Factors

Recent abortion (induced or spontaneous), particularly self-induced or in unsafe conditions
Retained products of conception
Pre-existing pelvic infection or sexually transmitted infection
Use of non-sterile instruments or unsterile abortion technique
Foreign body retention in the uterus
Immunocompromised state, diabetes
Bacterial vaginosis or untreated cervical infection at time of abortion

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Fever, chills or signs of infection after abortion or miscarriage
  • Foul-smelling vaginal discharge or heavy bleeding
  • Severe pelvic or abdominal pain
  • Persistent vaginal bleeding beyond expected duration
  • Signs of sepsis: rapid heart rate, low blood pressure, confusion
  • Dark urine or jaundice (concerning for Clostridium infection)
  • Decreased urine output, weakness, severe weakness

Treatment Methods

01
Immediate hospitalization for severe infection or sepsis; consider ICU admission for hemodynamic instability
02
Initial assessment: vital signs, complete blood count, electrolytes, lactate, blood cultures, urine and wound cultures, coagulation, type and crossmatch
03
Pelvic examination, transvaginal ultrasound to identify retained products of conception, abscess, free fluid
04
Empiric broad-spectrum IV antibiotics (covering anaerobes, gram-positives and gram-negatives): clindamycin plus gentamicin or piperacillin-tazobactam plus vancomycin
05
Add specific coverage for Clostridium if suspected (penicillin G plus clindamycin)
06
Aggressive fluid resuscitation, vasopressors if needed for septic shock
07
Uterine evacuation by manual vacuum aspiration or curettage within 6–12 hours after starting antibiotics for retained products
08
Surgical drainage of pelvic abscesses by interventional radiology or surgery
09
Hysterectomy for refractory infection, severe Clostridium infection, uterine perforation or necrosis
10
Tetanus prophylaxis if appropriate
11
Post-discharge: counseling about future contraception, sexually transmitted infection screening, fertility implications

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.