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  • Title: [Debatable questions in the classification and therapy of the infectious complications of abortion].
    Author: Rotkina IE.
    Journal: Akush Ginekol (Mosk); 1986 Aug; (8):24-7. PubMed ID: 2945472.
    Abstract:
    Depending on the extent of infection, abortions are usually classified as uncomplicated infected (feverish) abortions, in which only the fertilized egg and uterus are infected; complicated infected abortions, in which infection has spread beyond the uterus but remains localized in the pelvis minor; and septic abortions, in which infection has spread beyond the pelvis minor and become generalized. Disagreements are possible when defining uncomplicated and complicated abortions, since the term "infection within the uterus" can signify several inflammatory disorders varying in degree of severity and extent. The term "septic abortion" has also taken on a certain ambiguity and is even used to denote any abortion complicated by infection. The terms "septic abortion" and "septic condition" are often used synonymously. Infected abortions with clinical manifestations of septicemia are sometimes classified as "high-fever abortions" or "feverish abortions" with "septic abortion" syndrome. Recommendations for therapy are given: 1.) In uncomplicated infected abortions, the method of treatment is curettage of the uterus in the 1st hours after admission into the hospital. Medicinal preparation conducted for 2-6 hours before curettage reduces by nearly 1/3 the danger of inflammation spreading from the uterine cavity to the myometrium. 2.) When treating patients with complicated infected abortions, expectant-active treatment yields the best results. Curettage of the uterus is safe only after normalizing temperature, alleviating symptoms of toxic poisoning, and reducing local manifestations of infections. 3.) For patients with pronounced toxic poisoning related to resorptive-toxic fever or septicemia, clinical and laboratory observation and treatment must be conducted according to general procedures for acute sepsis therapy. Considering the special diathesis of these patients to septic shock, special measures to prevent shock should include increasing the dosage of antihistamines, medium doses of corticosteroids, and individually selected doses of heparin. This increases resistance to active intervention and the related entry of toxic substrate from the uterus into the blood stream. 4.) Treatment for an abortion complicated by generalized infection (septic abortion) should include radical surgical intervention on the primary septic source. The time and extent of surgical intervention are determined in each specific case individually, depending on the nature of the complication (sepsis, peritonitis, anaerobic infection) and condition of the patient. 5.) If indications develop for removal of the uterus, preference should be given to extirpation over amputation, since the harshest changes are usually localized in the isthmus of the uterus.
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