Postabortion Endometritis Research Articles

Septic shock and the obstetrician/gynecologist.

Septic shock continues to be a serious problem with a mortality ranging from 11% to 82%, depending upon the cause, the time of diagnosis, and the type of treatment. The condition is seen in pregnant patients with postabortal or postpartal endometritis, chorioamnionitis, and pyelonephritis. In gynecology patients it is seen after severe pelvic infection and in immunosuppressed patients with gynecologic cancer. Prompt diagnosis, adequate monitoring and vigorous treatment are essential if deaths are to be reduced. Over the period July 1, 1959, to June 30, 1981, 91 patients were treated for septic shock with a mortality of 18%. Although medical treatment is important, the most important aspect of treatment for most patients is removal of the septic focus.

Susceptibility of abortion patients to infection: Correlation to cervical flora.

Cervical bacterial microflora was studied with a semiquantitative method in 29 women both before and after the termination of their pregnancy. The main findings were high prevalence of anaerobic bacteria (in 72%-79% of the specimens) consisting predominantly of Bacteroides species and anaerobic Gram-positive cocci, and low prevalence of aerobic bacteria (in 24%-38% of the specimens). Among the other microbes studied, the prevalence of Chlamydia excretors was high (24%), probably reflecting a promiscuous study population. Seventeen percent of the women developed febrile postabortion endometritis or salpingits. However, the cervical culture results predicted neither the patient prone to infection nor her response to antimicrobial treatment, suggesting the need for more data concerning the virulence properties of the bacteria, together with isolation of the organism from an infected site.

Evaluation of fetal heart rate variability by a visual semiquantitative method and by a quantitative statistical method with the use of a minicomputer

Endometritis is seen quite commonly in association with retained placental or decidual tissue after an abortion. Repeat curettings in these cases reveal devitalized, necrotic decidual fragments associated with heavy leukocytic infiltrate, a condition known as “postabortion endometritis.” The necrotic decidua -can be recognized microscopically by the presence of “ghosts” of the large decidual cells with prominent large nuclei. The latter eventually disappear and are replaced with homogeneous eosinophilic acellular tissue. The healing process is characterized by the development of granulation tissue and eventually fibrosis may ensue. Calcification and ossification developing in the old, healed inflammatory tissue, or in the area of an old hemorrhage, have long been recognized and examples such as ossification in atherosclerotic plaques, in lungs subjected to long-standing chronic passive congestion, or in old, healed granulomas abound. Ossification developing in the process of postabortion endometritis occurs, in our opinion, in the same manner, because of the inherent metaplastic properties of the mesenchyma1 cells that participate in the healing process. The endometrial bone formation thus described should be clearly set apart from a phenomenon of fetal tissues implanted in the uterus during curettage and subsequently found in the endometrium or endocervix. The tissues found in these cases have included bone, cartilage, muscle, and neuroglia. Roth and Taylor2 found only one case with foci of bone formation among their nine cases of heterotopic cartilage in the uterus, apparently unrelated to a previous abortion. They favored metaplasia of the stromal cells as the origin of the cartilage in their cases because of the finding of apparent transitional areas in three instances and because of the presence of acid mucopolysaccharides in the endometrial stroma adjacent to the cartilage.2 The appearance of mature bony spicules is easily distinguishable from that of malignant mixed Miillerian tumor or of teratoma. Their finding in the endometrial curettings should in no way cause contemplation of hysterectomy. The ossified fragments are most probably expelled with the menstrual discharge within several months, as apparently was the case in the patient described by Hsu.’

The relationship of immediate post-abortal intrauterine device insertion to subsequent endometritis: A case-control study

A case-control study examining the risk for post-abortal endometritis in patients undergoing an immediate intrauterine device insertion after suction curettage for first trimester elective abortion was completed. The relative risk for endometritis in patients receiving the Dalkon Shield and Lippes Loop respectively was 0.56 and 0.33 when endometritis cases were matched with suitable controls. The significance of this finding and possible sources of bias are discussed.

Untreated endocervical gonorrhea and endometritis following elective abortion

A matched-pair analysis of 228 cases of endometritis occurring over a two-year period in 4,823 elective abortion patients was carried out. Patients with postabortal endometritis were matched with control subjects for age, parity, race, pay status, time of abortion, and type of abortion procedure. The prevalence of endocervical gonorrhea was 2.7 per cent in the entire group seeking abortion, with 14.7 per cent of patients with gonorrhea subsequently developing endometritis. The matched-pair analysis detected a threefold increased risk for endometritis in patients with untreated gonoccocal endocervicitis when compared with control subjects (p < 0.05). The significance of these findings to centers performing abortions is discussed.

Treatment of inflammatory pelvic disease with a long-acting oral penicillin preparation

1.1. The results of treatment of 59 patients with post-partum and post-abortion pelvic infections are reported.2.2. Eighty per cent of these infections were caused by penicillin-sensitive organisms, and 68 per cent of the infections were caused by staphylococci.3.3. Treatment with a long-acting penicillin tablet on a 12 hourly dosage schedule resulted in cures in 77.2 per cent, improvement in 11.4 per cent, and failures in 11.4 per cent of cases of postpartum endometritis 96 hours after treatment was begun. This compares favorably with 80 per cent cures, 11.4 per cent improved, and 8 per cent failures in a similar group of patients treated with equal doses of penicillin administered parenterally.4.4. In postabortion endometritis, the corresponding figures are 82, 13.5, and 4.5 per cent by oral treatment, and 86, 9, and 4.5 per cent by parenteral treatment.5.5. In those cases where the infection had spread to the adnexa and produced pelviperitonitis, both oral and parenteral penicillin were ineffective even though treatment was continued for more than 2 weeks. In one case (No. 54), tuberculous endometritis was subsequently diagnosed.