Postabortal Infection Research Articles

Metronidazole Fails to Prevent Postabortion Infection

Metronidazole Fails to Prevent Postabortion Infection

The role of vaginal secretory immunoglobulin A, Gardnerella vaginalis, anaerobes, and Chlamydia trachomatis in postabortal pelvic inflammatory disease.

In a prospective study of 129 women undergoing induced first-trimester abortion, 14 (10.9%) contracted postabortal pelvic inflammatory disease (PID). Samples of vaginal secretion for quantitation of secretory immunoglobulin A (sIgA) as well as isolates from cervix/urethra for the culture of anaerobes and aerobes, including Bacteroides fragilis et melaninogenicus and Gardnerella vaginalis, were obtained at the preoperative visit. Two blood samples from each woman with postabortal PID were analysed for antibodies against G. vaginalis. Twenty-five per cent of women with a history of PID developed postabortal PID, and 25% with vaginitis contracted postabortal infection (p less than 0.001 and p less than 0.005). Twenty-five per cent of women harboring C. trachomatis at the time of abortion developed infection. The presence of anaerobes or G. vaginalis was not associated with the frequency of postabortal PID (all p-values greater than 0.1). One woman with postabortal PID produced a culture positive for G. vaginalis and a rise in specific antibody titer. The levels of vaginal sIgA were not significantly associated with a positive history of PID (p greater than 0.6), with postabortal PID (p greater than 0.4) or with the presence of anaerobes or G. vaginalis at the time of abortion (p greater than 0.3). However, significantly elevated levels of sIgA were found in women harboring C. trachomatis (p less than 0.05). Thus, the study could not demonstrate any correlation between vaginal sIgA and PID, but increased sIgA in Chlamydia-positive women. A history of PID and vaginitis entailed a significant risk of contracting postabortal PID.

4 - Preparation of the Cervix: Hydrophilic and Prostaglandin Dilators

The use of laminaria has made possible safe uterine evacuation in the second-trimester and has been identified as a protective factor in the prevention of uterine perforation in first-trimester abortion. Two additional approaches to cervical dilation are now available – synthetic hydrophilic dilators and prostaglandin analogues. Neither has been in use long enough to undergo thorough evaluation, but it seems possible that they may confer similar advantages while avoiding the discomfort and inconvenience associated with laminaria. New approaches to the use of laminaria have increased their value as cervical dilators. They may be left in the cervix for 6–48 hours. Multiple sets may be employed to achieve adequate cervical dilation for late second-trimester uterine evacuation. When fetal membranes are intact, prolonged use or multiple insertions of laminaria do not appear to increase rates of post-abortion infection. Lamicel and Dilapan are new synthetic dilators which affect the cervix much more rapidly than laminaria. The former does not apply radial force to the walls of the cervical canal, but the latter does. Significant dilation may be achieved in a few hours. Prostaglandins can also alter the cervix in only a few hours. Meteneprost appears to do so with minimal gastrointestinal side-effects and with a low risk of bleeding or abortion.

8 - Impact of Abortion on Subsequent Fecundity

The impact of abortion on subsequent fecundity has been extensively studied, especially since abortion was legalized in Eastern Europe during the 1950s and 1960s and in Western Europe and the USA during the 1960s and 1970s. A review of this literature reveals a number of consistent findings. First, women who choose to have their first pregnancy terminated are at no increased risk of failing to conceive at a later date. Exceptions include abortions complicated by infection leading to pelvic inflammatory disease (PID). However, this combination of factors occurs very infrequently. Second, women whose first pregnancy is terminated by vacuum aspiration are at no increased risk of subsequent ectopic pregnancy. Exceptions may be women whose abortion is complicated by pre-existing C. trachomatis and others who experience post-abortion infection leading to PID. Third, women whose first pregnancy is terminated by vacuum aspiration are at no increased risk of subsequent mid-trimester spontaneous abortion, preterm delivery or low birthweight, when compared with women who are pregnant for the first time. Fourth, women whose first pregnancy is terminated by D&C may have an increased risk of subsequent ectopic pregnancy, mid-trimester spontaneous abortion and low birthweight. Fifth, more research is needed before it is clear whether multiple induced abortions carry an increased risk of adverse pregnancy outcomes. Finally, too little is known about fecundity following mid-trimester abortion procedures to state definitively that they carry no increased risk of adverse outcomes. However, studies to date suggest that instillation procedures carry little, if any, excess risk. Risks related to dilation and evacuation, if any, may be related to the method and extent of cervical dilation.

Antibiotic Treatment May Prevent Postabortion Infection, but Some Studies Show No Benefit

Antibiotic Treatment May Prevent Postabortion Infection, but Some Studies Show No Benefit

Midtrimester Abortion: Techniques and Complications

Midtrimester abortion may be accomplished by a variety of techniques, alone or in combination. Comprehensive care of patients who require or request pregnancy termination in the second trimester must include careful assessment of medical and psychological conditions. Special attention needs to be paid to gestational age, and for many cases ultrasonography should be part of the evaluation. With the variety of techniques and combinations available, physicians can now individualize patient care to minimize morbidity and mortality while improving patient comfort and well being.

Prolonged intrauterine retention of fetal bones after abortion causing infertility

This case study discusses a patient with prolonged intrauterine retention of parts of the fetal skeleton. A 22 year old black woman presented with secondary infertility. After almost 1 year of attempted diagnosis, a hysteroscopy was performed and a white-appearing tubular structure which was similar to the noncopper-bearing portion of an IUD appeared to be embedded in the fundus. Removal was difficult and the removed segments proved to be bone. Results indicated there were bits of fetal bone partially embedded at the fundal portion of the uterus for 6 years after an induced abortion. Curettage yielded several more bone bits; repeat hysteroscopy confirmed that the uterus was empty. The patient have an uneventful postoperative recovery and is being followed up. There appears to be no other previously published report of fetal bones retained for up to 5 years after an abortion by dilatation and curettage. These bones could have contributed to this patient's postabortion infection. The value of hysteroscopy was clearly demonstrated in this case. Curettage alone could have missed the bones but hysteroscopy enabled the physicians to visualize the bones and their location. The authors speculate that the presence of the bones acted as a uterine synechia or an IUD and thus prevented pregnancy. It is also possible that the presence of bones near the fundal region elevated endometrial postaglandin F2alpha concentration in that region and rendered her infertile.

Preoperative Cervical Microbial Flora and Post‐Abortion Infection

With the aim to find criteria for the prediction of the patients who are at risk of developing a post-abortion infection the pretreatment cervical microbial flora was compared between one series of patients who developed and another series of patients who did not develop such an infection. Aerobic and anaerobic bacteria as well as mycoplasma and fungi, were studied in 104 patients. The distribution of aerobic and anaerobic bacteria was similar in the 14 patients who later developed post-abortal infection and in uncomplicated cases. It is concluded that the cultivation of the cervical microbial flora cannot serve as a basis for the prediction of which patients will develop subsequent genital infections.

Extraovular prostaglandin F2α for early midtrimester abortion

Twenty patients who were 13 to 15 weeks pregnant received extraovular prostaglandin F2-alpha (PGF2α) in dosages of 3 mg. every 1 to 3 hours. Ninety-five per cent of the patients successfully aborted and 30 per cent of the patients had retained placental tissue. The mean abortion time was 17¾ and the average total dose used was 29.2 mg. The abortion time appeared to decrease with parity and had no relationship to weeks of gestation. Only one patient failed to abort after 31 hours of therapy. She required a curettage and was the only patient to develop a postabortion infection. The technique appears to compare favorably with the results of intra-amniotic PGF2α. Extraovular prostaglandin may therefore be of particular value in inducing abortion in patients who are in the early midtrimester of pregnancy, i.e., when intra-amniotic instillation is technically infeasible.

Post-Abortal Infection: New Approaches to an Old Problem

Post-Abortal Infection: New Approaches to an Old Problem

Utero-Tubal Implantation

Based on both personal series data and literature review the author attempts to assess the success and indications of tubal plastic surgery. The following possible etiologies for tubal obstruction or disease requiring reversal are discussed: 1) congential 2) trauma (surgery) 3) postabortal infection and 5) spasm (he does not discuss tuberculosis). Problems of diagnosis are discussed. Tubal patency tests are known to be unreliable with the author citing numerous series where retesting by hysterosalpingogram reduced incidences of suspected tubal blockage from 21% to 9%. After confirming diagnosis of tubal obstruction various techniques are available for reversal attempts; this author describes tubal transplantation. As part of techniques described for transplantation the following 3 steps are included: 1) use of some form of reamer (which this author has had little success with); 2) use of polyethylene rods (which this author has had no success with also preferring temporary sutures which can be removed through the cervix); and 3) use of cortisone (of which he had no personal knowledge). Certain aspects of tubal reconstruction/transplantation surgery stand out from viewing the data of this persons personal series: 1) if tubes are normal good results will follow (e.g. poststerilization myomectomy) 2) true cases of postabortal obstruction of the interstitial area of the fallopian tube with the remaining tube in good shape are very rare but have good prognosis; and 3) obstructed tubes caused by generalized interstitial salpingitis are rarely helped by surgical intervention.

Management of postabortal infections complicated by acute renal failure

A FAVORABLE OutCOnE is usually anticipated when acute renal failure is associated with pregnancy.le5 The individuals in this group are young and rarely have underlying renal disease. However, in sharp contrast, the renal failure which develops in such patients during the course of septic abortion has a very high mortality.6-10 This low survival rate occurs with overwhelming infections such as those due to Clostridium wetchii.1’-14 The conservative management of such patients, including artificial hemodialysis, has not sufficiently decreased this mortality. In a small experience with 4 such desperately ill patients, conservative management including hemodialysis failed to produce any patient survivals. More recently we have added hysterectomy in an attempt to improve these results. Of the last 3 patients so treated, 2 have survived. Obviously many more will have to be so treated to indicate a more accurate survival rate. In one of the conservatively managed cases a curettage was performed (Case 4). This patient died in the diuretic phase of the illness just prior to a proposed second hemodialysis. ‘In case 7 the patient died following hys-

Postabortal septicotoxemia due to clostridium welchii: Seventy-Five cases from the maternity hospital, Santiago, Chile 1948–1952

1.1. Seventy-five cases of postabortal infection with Clostridium welchii are presented. These occurred from 1948 to 1952 at the Maternity Hospital in Santiago, Chile.2.2. The incidence of this infection at this hospital among all patients with abortion was 1 in 307.3.3. The symptoms and clinical course of these cases are described. The diagnostic triad of hemoglobinuria, hemoglobinemia, and a deep bronze icterus leaves no difficulty in the diagnosis of this disease.4.4. The course of the disease is described as occurring in two phases, the icterohemolytic syndrome and the hepatorenal syndrome.5.5. The mortality rate was 73.3 per cent, with a decrease in mortality rate from 87.5 per cent early in the series to 68.7 per cent in the last year.6.6. Twenty-three (30 per cent) of these patients developed anuria; 94.6 per cent had oliguria some time during the course of their illnesses.7.7. Laboratory and pathological findings are described.8.8. Treatment was directed along three basic lines, removing the focus of infection in the uterus, specific treatment with Perfringens antitoxin and antibiotics, and supportive treatment.9.9. Although the outcome of any given case depended primarily on the virulence and toxicity of the organism, treatment as outlined appeared to offer a better chance of survival.10.10. The serious abortion problem in Chile is decried and a plea for preventive measures to curtail it made.

New etiological factor in ectopic pregnancy.

In accepting the benefits of recent advances in the treatment of a disease, the clinician must be thoroughly acquainted not only with the favorable alterations in the clinical course of the condition under treatment but with the undesirable sequelae as well. Since the advent of antibiotics, particularly penicillin, the clinical course of infections of the female pelvic organs has radically changed. The number of patients who have been spared surgery or invalidism is gratifying. Most patients with acute salpingitis or acute postabortal infections, if treated early with penicillin, are left with little or no residual damage. Thus, the incidence of sterility following these infections has been reduced considerably. Several years ago we reported results of the use of intramuscularly administered penicillin in the treatment of a series of patients with chronic endocervicitis. 1 At that time definite improvement was noted in 94.5% of the patients. More recently the response to

POSTABORTAL INFECTION WITH CLOSTRIDIUM WELCHII

BJOG: An International Journal of Obstetrics & GynaecologyVolume 56, Issue 4 p. 636-647 POSTABORTAL INFECTION WITH CLOSTRIDIUM WELCHII Report of 2 Cases with Special Reference to Oliguria and to Penicillin Treatment Mary A. M. Bigby M.D., M.R.C.O.G., Mary A. M. Bigby M.D., M.R.C.O.G. Obstetrician and Gynaecologist, Central Middlesex Hospital, LondonSearch for more papers by this authorF. Avery Jones M.D., F.R.C.P., F. Avery Jones M.D., F.R.C.P. Physician, Central Middlesex Hospital, London.Search for more papers by this author Mary A. M. Bigby M.D., M.R.C.O.G., Mary A. M. Bigby M.D., M.R.C.O.G. Obstetrician and Gynaecologist, Central Middlesex Hospital, LondonSearch for more papers by this authorF. Avery Jones M.D., F.R.C.P., F. Avery Jones M.D., F.R.C.P. Physician, Central Middlesex Hospital, London.Search for more papers by this author First published: August 1949 https://doi.org/10.1111/j.1471-0528.1949.tb07133.xCitations: 12AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume56, Issue4August 1949Pages 636-647 RelatedInformation

GAS BACILLUS INFECTION OF THE UTERUS TREATED WITH PENICILLIN

Abstract A case of postabortal infection with Clostridium welchii is reported, in which treatment with penicillin apparently confined the infection to the uterus. However, it had no effect upon the process within that organ. The uterus continued to enlarge and was exquisitely tender until the patient was given, in addition, sulfadiazine, and local treatment with zinc peroxide. Recovery was then uneventful except for an attack of hepatitis on the seventeenth and eighteenth postabortal days. Our thanks are due to Dr. T. D. Davis for this valuable advice in outlining the treatment in this case.

Gas bacillus infection of the uterus treated with penicillin

A case of postabortal infection with Clostridium welchii is reported, in which treatment with penicillin apparently confined the infection to the uterus. However, it had no effect upon the process within that organ. The uterus continued to enlarge and was exquisitely tender until the patient was given, in addition, sulfadiazine, and local treatment with zinc peroxide. Recovery was then uneventful except for an attack of hepatitis on the seventeenth and eighteenth postabortal days. Our thanks are due to Dr. T. D. Davis for this valuable advice in outlining the treatment in this case.

A preliminary report on the use of sulfanilamide in puerperal and postabortal infections

A preliminary report on the use of sulfanilamide in puerperal and postabortal infections