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  • Title: The parameters of septic abortion.
    Author: Botes M.
    Journal: S Afr J Obstet Gynaecol; 1971 Sep 11; 9(2):37-41. PubMed ID: 12276391.
    Abstract:
    A retrospective analysis of 50 cases of septic incomplete abortion is made. In order to evaluate the spread of infection, septic abortions were grouped into 3 types. In Group 1 were cases with infection limited to the uterus alone. Group 2 included cases with extrauterine spread of infection to parametrium and/or adnexa, and Group 3 cases had pelvic or generalized peritonitis. The purpose of the study was 1) to correlate bacterial cultures with the clinical classification and with special reference to the offensive vaginal discharge; 2) to determine whether there is a dominant clinical parameter; and 3) to evaluate, after consideration of 1 and 2, whether endotoxic shock can be prevented by prophylactic treatment. The clinical picture, vaginal discharge, bacteriologic cultures of the cervix and uterine cavity and the histopathological picture of the uterine curettements were correlated. The mean temperature on admission was 98.9 degrees F in Group 1, 101 degrees F in Group 2, and 102.4 degrees F in Group 3. Of the cases with a history of criminal intervention 9 percent were in Group 1; 57 percent in group 2, and 86 percent in Group 3. In Group 1, 14 percent had offensive discharge, although 23 percent yielded positive cervical cultures and 9 percent positive uterine cultures. In Group 2, the discharge occurred in 57 percent, and positive cervical and uterine cultures were 43 percent and 33 percent respectively. The cases with peritonitis (Group 3) showed a very strong correlation: 71 percent offensive discharge with 86 percent cervical cultures and 71 percent positive uterine cultures. Analysis of the positive neutrophil responses showed that in Group 1 there was a 75 percent positive and a 25 percent negative response, in Group 2 there was a 40 percent positive and a 60 percent negative response, and in Group 3 there was a 30 percent positive and a 70 percent negative. It appeared that the more overwhelming the infection, the less was the response of the body against the infection. It is suggested that suspicion of criminal intervention might still be the only dominant clinical parameter to justify aggressive prophylactic treatment, if the patient would only give this information more freely. It is concluded that a septic abortion is any abortion where tenderness (indicating infection) can be elicited on bimanual examination. A classification of cases into the 3 groups is suggested. Group 2 and 3 cases should be evacuated vaginally without delay.
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