Clinical Conundrum: Neisseria meningitidis Septic Abortion.

Septic shock after abortion is an important cause of global maternal mortality but is rarely encountered in developed countries. We describe a case of septic abortion with a novel associated pathogen: Neisseria meningitidis. A 30-year-old multiparous woman presented in septic shock after an incomplete spontaneous abortion. She received empiric antibiotics and vasopressors, underwent an urgent dilatation and curettage, and was admitted to the intensive care unit. Her blood cultures and endometrial tissue were positive for N. meningitidis. Antibiotics were adjusted based on culture, and the patient recovered. Septic shock requires prompt identification, antibiotic administration, and source control. Here, we identify an uncommon pathogen associated with septic abortion and highlight the importance of broad empiric and subsequent culture-guided antibiotic choice to ensure coverage.

Utero-adnexal damage in septic abortion. Histopathological study on 91 cases.

Septic abortion represents the main causes of abortion-induced maternal death. Hysterectomy may represent a beneficial therapeutic solution for septic abortion, nevertheless with irreversible effects on a woman's reproductive condition. The study analyzes the anatomopathological damage found in ninety-one patients hospitalized for septic abortion. The patients were admitted to the "Dr. D. Popescu" Clinical Hospital, Timisoara, between 1980-1989 and 1999-2008; hysterectomy was performed in all the cases to eliminate uterine sepsis responsible for the emerging complications.

[Septic abortion with massive coagulopathy and subsequent acute hysterectomy].

Septic abortion is a rare, but potentially life-threatening condition. Quick diagnosis and treatment is essential for the outcome. This case report describes a healthy 34-year-old woman who was admitted with abdominal pain, fever and an ongoing spontaneous abortion at gestational age week 13 + 6 days. During evacuation severe bleeding and coagulopathy was seen. She was treated with multiple coagulation products but due to a life-threatening situation an acute hysterectomy was performed. She was discharged after nine days.

Septic abortions: a descriptive study in a teaching hospital at North Bengal, Darjeeling.

A hospital based cross sectional study for one year done among 57 diagnosed and admitted septic abortion cases, revealed that 71.9% septic abortions were performed by untrained persons, 63.2% mothers were illiterate, 22.8% mothers were in adolescent age group. Exploratory Laparotomy was needed in 46.3% cases and important complications for referring were severe anaemia and septic shock.

Septic abortion presenting as a right lower trapezius abscess secondary to Bacteroides fragilis bacteraemia.

A 43-year-old Japanese woman was evaluated in the outpatient department for right shoulder pain and fever, which began 5 days earlier. MRI of the right shoulder revealed a high-intensity area deep in the right trapezius muscle. Aspiration revealed purulent fluid, and Gram staining of the fluid showed Gram-negative bacilli. The patient was also found to be profoundly anaemic and to have a positive urine pregnancy test. On admission, we initiated intravenous ampicillin-sulbactam and aztreonam. She underwent dilatation and curettage for septic abortion and surgical drainage of the right shoulder abscess. Bacteroides fragilis was isolated from the blood, uterine aspiration and abscess samples. On hospital day 4, a whole-body CT scan revealed no other abscesses, and ampicillin-sulbactam was continued for 28 days. The patient was discharged on hospital day 29. Gram staining is an important tool for evaluating infectious aetiologies.

Septic abortion with placenta accreta in pregnancy after endometrial ablation.

BACKGROUND: Pregnancy after endometrial ablation is a rare event, occurring in approximately 0.7% of cases. When it occurs, serious complications may be anticipated for both mother and fetus, including abnormal placentation. Termination of pregnancy in these cases is a challenging issue, made more so by the lack of availability of these services. CASE: We report a case of pregnancy after endometrial ablation complicated by placenta accreta. Initiation of a second-trimester termination procedure with lethal fetal injection resulted in subsequent septic abortion necessitating abdominal hysterectomy. CONCLUSION: Pregnancy after endometrial ablation is a rare and potentially morbid event. Patients should be counseled about the necessity of contraception at the time of endometrial ablation. Termination should be approached with caution and requires the availability of skilled providers.

Surgical management of diffuse peritonitis complicating obstetric/gynecologic infections.

A retrospective review of 176 women undergoing surgery for diffuse peritonitis secondary to pelvic infections from 1972 to 1976 was conducted. Mortality with septic abortion was 27.3% (12 of 44), with pelvic inflammatory disease 7.1% (eight of 113), and with puerperal sepsis 6.7% (one of 15). Overall mortality was 13.1% (23 of 176). Mortality was lower (P less than .05) with surgery within 24 hours (7.5%, six of 80) than after 24 hours (17.7%, 17 of 96). Mortality was lower (P less than .01) with specific antianaerobic antibiotics (zero of 36) than without (16.4%, 23 of 140). Mortality was 21.3% with hysterectomy (ten of 47) and 10.1% (13 of 129) with conservative surgery, however hysterectomy was usually performed in the more severe cases (septic abortion 75%, puerperal sepsis 66%, pelvic inflammatory disease 3%). Mortality declined from 17.6% in 1972 to 1974 (21 of 119) to 3.5% in 1975 to 1976 (two of 57). Significant differences between the two periods included an increased use of specific antianaerobic antibiotics (8.4%/45.5%) and an increased incidence of early surgery (35.3%/66.6%) in the latter years. This series emphasizes the overriding importance of early surgery and the need for the inclusion of specific antianaerobic antibiotic agents in the chemotherapeutic regimen.

Bowel injury in septic abortion: the need for more aggressive management.

An analysis of bowel injury in cases of septic abortion treated over a six-year period at the University of Nigeria Teaching Hospital at Enugu is presented. Seventy-three percent (11/15) of the patients who underwent laparotomy had concomitant injury to the bowels. Overall, 16.4% of the 67 patients with septic abortion had intestinal injuries (this does not include the patients who died as a result of fulminating peritonitis before surgery could be performed). The survival of those patients with intestinal injuries was very much dependent on the operative procedures adopted. When a dysfunctioning colostomy was raised, the mortality was nil. In patients who had simple closure of the perforation and in those who had primary resection and anastomosis, mortality was 66.6%. The importance of performing laparotomy much sooner than usual is discussed.

A review of septic induced abortion cases in one year at Khyber Teaching Hospital, Peshawar.

BACKGROUND: Working in a tertiary level hospital we get complicated cases as a result of termination or attempts at termination of unwanted pregnancies. Most of the patients that we get are complicated and need expensive treatments including surgery. This study was conducted to assess the out come of septic induced abortion cases in a year. METHODS: It was conducted at the Department of Obstetrics and Gynaecology, unit B, Khyber Teaching Hospital, Peshawar, from 1.7.01 to 30.6.02. The data of a total of 28 patients admitted as emergency cases with septic induced abortion in above period were collected. History, management given, post operative care, complications and associated morbidity and mortality were taken into account and result compiled. RESULTS: 78.5% patients with unsafe abortions were multi gravida. Termination was attempted at home or other small centers. 57%, had history of surgical interference, 28.5% had used a mechanical device. 78.5% patients needed evacuation and curettage, 42% had laparotomy for visceral injuries. 15% patients had a subtotal hysterectomy. 57% patients had associated complications. 7.5% patients who came with septicemic shock died. CONCLUSION: Septic induced abortion is an important contributor to maternal morbidity and mortality, increasing the burden on not only the patients but health workers and their resources. However, it is preventable, and we suggest commitment to health education, family planning promotion and bringing down the rates of unsafe abortions as solutions to the problems.

[Septic cervical pregnancy. A case report]. / Embarazo séptico cervical. Informe de un caso.

One clinical case of cervical pregnancy studied at the General Hospital of Acapulco, Guerrero, México, is presented clinically it was manifested as septic abortion and diagnosed by ultrasonography. In the past 12 years of establishment, 30,000 deliveries have been recorded and during this period, only four well documented cases were found and two of the previously reported by one us. Only two cervical pregnancy presenting as abortion, a relationship not emphasized in literature, was made in 1975.

Reflections on the 24 years durability of an isolate tricuspid bovine pericardium IMC/Braile bioprosthesis.

We were challenged by the experience of one patient reoperation for a bioprosthetic bovine pericardium degenerative stenosis, 24 years after implantation. This bioprosthesis was implanted due to tricuspid valve bacterial staphylococcal endocarditis after septic abortion.

Aborto séptico por Clostridium perfringens complicado con shock séptico / Septic abortion due to Clostridium perfringens complicated with septic shock

ANTECEDENTES: La sepsis por Clostridios es una entidad poco frecuente que conlleva una mortalidad del 8090% a pesar del tratamiento antibiótico y quirúrgico. A pesar de que la mayoría de los casos de septicemia secundaria a Clostridios se originan en el aparato genital femenino tras un aborto séptico, solo un pequeño porcentaje de abortos sépticos (1%) se siguen de septicemia. CASO CLÍNICO: Gestante de 15 semanas que acude a urgencias por rotura prematura de membranas pretérmino. Ante el deseo de la paciente se mantiene actitud conservadora con antibioterapia iv, produciéndose a las pocas horas el aborto de forma espontánea junto con aparición de signos de infección. Rápidamente la paciente evoluciona a sepsis grave, y ante la sospecha de aborto séptico se efectúa histerectomía. Tras la intervención ingresa en situación de shock séptico con insuficiencia renal, hepática y respiratoria. Durante el ingreso se confirma Clostridium perfringens como agente responsable del proceso séptico. Finalmente la paciente es dada de alta definitiva tras seis meses, una vez resueltas las alteraciones derivadas del proceso séptico.

BACKGROUND: Clostridial sepsis is a rare condition which carries a mortality of 80-90% despite antibiotic and surgical treatment. Although most cases of septicemia due to Clostridium are originated in female genital tract after septic abortion, only a small percentage of septic abortions (1%) are followed by septicemia. CLINICAL CASE: Our case is about a 15 weeks pregnant woman attended the emergency room for preterm premature rupture of membranes. Due to the desire of the patient we proceed conservative treatment with antibiotics iv, in the following few hours the abortion develops spontaneously along with signs of infection. Rapidly the patient progresses into a severe sepsis, due to suspected septic abortion, the patient is intervened urgently by hysterectomy. After the intervention she enters into septic shock state with respiratory, kidney and liver failure. During the admission Clostridium perfringens is confirmed as a causative agent for septic process. Finally the patient is discharge after six months once resolved all complications arising from septic process.