Septic abortion and septic shock.

Abstract

Septic shock in obstetric cases is described, and patient management is discussed. Cases of septic abortion complicated by septic shock differ from those resulting from bacterial shock. During the 10 years prior to 1968, Boston City Hospital had a yearly average of 550-600 abortions, and about 26% were septic. Septic shock developed in 3.8% of patients. During 1968 and 1969, the number of abortions dropped to 491 and 461, respectively, with 107 septic for 1968 and 73 for 1969; during these years, only 4 cases had septic shock, but these resulted in 2 maternal deaths. Both of these cases had been mistreated due to inappropriate diagnosis. The pathophysiology and management of these cases are described. Most septic abortions complicated by septic shock result from gram-negative organisms which produce endotoxin; in addition, 2 gram-positive organisms, Clostridium welchii and C. perfringens, are frequently responsible for septic shock. Often, illegal abortion was the cause for septic abortion and shock, but it can also occur with prolonged ruptured membranes and chorioamnionitis in the last trimester. These patients presented with a variety of clinical symptoms, including septic shock. They required intensive therapy; about 95% of all septic abortions can be controlled and respond favorably to adequate antibiotic therapy and evacuation of uterine contents. If the patient fails to respond to this form of therapy, septic shock is frequently a complication. Under these circumstances, immediate surgical intervention, in the form of total abdominal hysterectomy and bilateral salpingo-oophorectomy, is performed, and the vaginal cuff is left open to allow for adequate drainage. Without such treatment, mortality rates increase to 60%. The use of vasopressors if central venous pressure is very low is recommended by this hospital group, Isuprel in particular. Exchange transfusion is advocated to combat hemolysis.