Septic abortion - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2022-06-07T21:46:45Z

Differential Diagnosis

← Revisión anterior		Revisión del 21:46 7 jun 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Abdominal Pain Pregnancy DDX}}		{{Abdominal Pain Pregnancy DDX}}

	{{VB DDX greater than 20}}		{{VB DDX greater than 20}}
			{{Postpartum emergencies DDX}}

	==Evaluation==		==Evaluation==

ClaireLewis at 17:49, 4 October 2019

2019-10-04T17:49:30Z

← Revisión anterior		Revisión del 17:49 4 oct 2019
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	==Background==		==Background==
	Spontaneous or induced abortion that is complicated by a pelvic infection<ref>Stubblefield, Phillip G., and David A. Grimes. "Septic Abortion." New England Journal of Medicine 331.5 (1994): 310-14.</ref>Endometritis (secondary to retained products of conception or using non-sterile instruments)		*Spontaneous or induced abortion that is complicated by a pelvic infection<ref>Stubblefield, Phillip G., and David A. Grimes. "Septic Abortion." New England Journal of Medicine 331.5 (1994): 310-14.</ref>
	**Leading to [[PID]] and peritonitis then bacteremia, sepsis, and death<ref>Finkielman, Javier et al. "The Clinical Course of Patients with Septic Abortion Admitted to an Intensive Care Unit." Intensive Care Medicine 30.6 (2004): 1097-102.</ref>		*[[Endometritis]] (secondary to [[retained products of conception]] or using non-sterile instruments)
			**Leading to [[PID]] and [[peritonitis]] then [[bacteremia]], [[sepsis]], and death<ref>Finkielman, Javier et al. "The Clinical Course of Patients with Septic Abortion Admitted to an Intensive Care Unit." Intensive Care Medicine 30.6 (2004): 1097-102.</ref>
	*Usually a polymicrobial infection<ref>Tintinalli, Judith E., and J. Stephan. Stapczynski. "Septic Abortion." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 682.</ref>		*Usually a polymicrobial infection<ref>Tintinalli, Judith E., and J. Stephan. Stapczynski. "Septic Abortion." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 682.</ref>
	**[[E. Coli]], [[Streptococcus]], [[anaerobes]] (Bacteroides), sexually transmitted pathogens		**[[E. Coli]], [[Streptococcus]], [[anaerobes]] (Bacteroides), sexually transmitted pathogens
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	==Clinical Features==		==Clinical Features==
	*Abdominal or pelvic pain		*[[abdominal pain\|Abdominal]] or [[pelvic pain]]
	*[[Nausea Vomiting in Pregnancy\|Nausea/~~Vomitting~~]]		*[[Nausea Vomiting in Pregnancy\|Nausea/Vomiting]]
	*[[Vaginal_Bleeding_Pregnant_(less_than_20wks)\|Vaginal bleeding]]		*[[Vaginal_Bleeding_Pregnant_(less_than_20wks)\|Vaginal bleeding]]
	*Vaginal discharge		*[[Vaginal discharge]]
	*Cervical motion tenderness		*Cervical motion tenderness
	*[[Hypotension]], tachycardia, fever, tachypnea		*[[Hypotension]], [[tachycardia]], [[fever]], [[tachypnea]]
	*History of recent pregnancy or known induced or spontaneous abortion		*History of recent pregnancy or known induced or spontaneous abortion
	*Usually delayed presentation (48 hours after onset of symptoms) secondary to the stigma of induced abortion		*Usually delayed presentation (48 hours after onset of symptoms) secondary to the stigma of induced abortion

			===Complications===
			*Need for hysterectomy and bilateral salpingo-oophorectomy <ref>Gaufberg, Salva V., MD, and Pamela L. Dyne, MD. "Abortion Complications."Abortion Complications. Medscape, 22 Oct. 2012.</ref>
			*Acute [[Renal Failure\|renal failure]], liver dysfunction, [[ARDS]], multisystem organ failure
			*[[DIC]]
			*[[Hemorrhage]] requiring [[pRBCs\|transfusion]]
			*Increased risk of [[ectopic pregnancy]] and infertility in the future

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Check coagulation panel to rule out [[DIC]]		*Check coagulation panel to rule out [[DIC]]
	*Pelvic exam – look for signs of trauma to cervix or vagina		*Pelvic exam – look for signs of trauma to cervix or vagina
	*~~Ultrasound~~ – check for intrauterine material, abdominal free fluid, pelvic [[abscess]]		*[[Pelvic ultrasound]] – check for intrauterine material, abdominal free fluid, pelvic [[abscess]]
	*CT or MRI – may show uterine emphysema or intraperitoneal air if uterine perforation has occurred		*CT or MRI – may show uterine emphysema or intraperitoneal air if uterine perforation has occurred

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	*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>		*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>
	*Assess for and control any vaginal bleeding		*Assess for and control any vaginal bleeding
	*Broad-spectrum antibiotics – ~~Ampicillin~~ 1-2 gm IV + ~~Gentamicin~~ 1-2mg/kg IV + ~~Clindamycin~~ 600-900mg IV or ~~Metronidazole~~ 500mg IV		*Broad-spectrum antibiotics – [[ampicillin]] 1-2 gm IV + [[gentamicin]] 1-2mg/kg IV + [[clindamycin]] 600-900mg IV or [[metronidazole]] 500mg IV
	*[[Tetanus]] vaccination		*[[Tetanus]] vaccination
	*Early OB consult – Most will need evacuation of any remaining products of conception		*Early OB consult – Most will need evacuation of any remaining products of conception
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	==Disposition==		==Disposition==
	*Admit		*Admit

	~~==Complications==~~
	*Need for hysterectomy and bilateral salpingo-oophorectomy <ref>Gaufberg, Salva V., MD, and Pamela L. Dyne, MD. "Abortion Complications."Abortion Complications. Medscape, 22 Oct. 2012.</ref>
	*Acute [[Renal Failure\|renal failure]], liver dysfunction, [[ARDS]], multisystem organ failure
	*[[DIC]]
	*Hemorrhage requiring transfusion
	*Increased risk of ectopic pregnancy and infertility in the future

	==See Also==		==See Also==

Ostermayer: Text replacement - "abscess " to "abscess "

2017-03-10T14:38:40Z

Text replacement - "abscess " to "abscess "

← Revisión anterior		Revisión del 14:38 10 mar 2017
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	*Check coagulation panel to rule out [[DIC]]		*Check coagulation panel to rule out [[DIC]]
	*Pelvic exam – look for signs of trauma to cervix or vagina		*Pelvic exam – look for signs of trauma to cervix or vagina
	*Ultrasound – check for intrauterine material, abdominal free fluid, pelvic abscess		*Ultrasound – check for intrauterine material, abdominal free fluid, pelvic [[abscess]]
	*CT or MRI – may show uterine emphysema or intraperitoneal air if uterine perforation has occurred		*CT or MRI – may show uterine emphysema or intraperitoneal air if uterine perforation has occurred

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T23:32:12Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 23:32 25 jul 2016
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	{{VB DDX greater than 20}}		{{VB DDX greater than 20}}

	==~~Diagnosis~~==		==Evaluation==
	*Clinical diagnosis; patient may be reluctant to share information that she had an unsafe abortion		*Clinical diagnosis; patient may be reluctant to share information that she had an unsafe abortion
	*Labs: CBC, blood type with Rh status, CMP, serum beta-hcg level, UA, blood cultures		*Labs: CBC, blood type with Rh status, CMP, serum beta-hcg level, UA, blood cultures

Neil.m.young: Text replacement - "2 mg" to "2mg"

2016-07-25T17:58:43Z

Text replacement - "2 mg" to "2mg"

← Revisión anterior		Revisión del 17:58 25 jul 2016
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	*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>		*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>
	*Assess for and control any vaginal bleeding		*Assess for and control any vaginal bleeding
	*Broad-spectrum antibiotics – Ampicillin 1-2 gm IV + Gentamicin 1-~~2 mg~~/kg IV + Clindamycin 600-900mg IV or Metronidazole 500mg IV		*Broad-spectrum antibiotics – Ampicillin 1-2 gm IV + Gentamicin 1-2mg/kg IV + Clindamycin 600-900mg IV or Metronidazole 500mg IV
	*[[Tetanus]] vaccination		*[[Tetanus]] vaccination
	*Early OB consult – Most will need evacuation of any remaining products of conception		*Early OB consult – Most will need evacuation of any remaining products of conception

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-21T00:11:16Z

Text replacement - "0 mg" to "0mg"

← Revisión anterior		Revisión del 00:11 21 jul 2016
Línea 45:		Línea 45:
	*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>		*2 large bore IVs; aggressive IV fluid resuscitation<ref>Osazuwa, Henry, and Michael Aziken. "Septic Abortion: A Review of Social and Demographic Characteristics." Archives of Gynecology and Obstetrics 275.2 (2007): 117-19. </ref>
	*Assess for and control any vaginal bleeding		*Assess for and control any vaginal bleeding
	*Broad-spectrum antibiotics – Ampicillin 1-2 gm IV + Gentamicin 1-2 mg/kg IV + Clindamycin 600-~~900 mg~~ IV or Metronidazole ~~500 mg~~ IV		*Broad-spectrum antibiotics – Ampicillin 1-2 gm IV + Gentamicin 1-2 mg/kg IV + Clindamycin 600-900mg IV or Metronidazole 500mg IV
	*[[Tetanus]] vaccination		*[[Tetanus]] vaccination
	*Early OB consult – Most will need evacuation of any remaining products of conception		*Early OB consult – Most will need evacuation of any remaining products of conception

Neil.m.young: Text replacement - "2/2" to "secondary to"

2016-07-04T07:04:11Z

Text replacement - "2/2" to "secondary to"

← Revisión anterior		Revisión del 07:04 4 jul 2016
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	==Background==		==Background==
	Spontaneous or induced abortion that is complicated by a pelvic infection<ref>Stubblefield, Phillip G., and David A. Grimes. "Septic Abortion." New England Journal of Medicine 331.5 (1994): 310-14.</ref>Endometritis (~~2/2~~ retained products of conception or using non-sterile instruments)		Spontaneous or induced abortion that is complicated by a pelvic infection<ref>Stubblefield, Phillip G., and David A. Grimes. "Septic Abortion." New England Journal of Medicine 331.5 (1994): 310-14.</ref>Endometritis (secondary to retained products of conception or using non-sterile instruments)
	**Leading to [[PID]] and peritonitis then bacteremia, sepsis, and death<ref>Finkielman, Javier et al. "The Clinical Course of Patients with Septic Abortion Admitted to an Intensive Care Unit." Intensive Care Medicine 30.6 (2004): 1097-102.</ref>		**Leading to [[PID]] and peritonitis then bacteremia, sepsis, and death<ref>Finkielman, Javier et al. "The Clinical Course of Patients with Septic Abortion Admitted to an Intensive Care Unit." Intensive Care Medicine 30.6 (2004): 1097-102.</ref>
	*Usually a polymicrobial infection<ref>Tintinalli, Judith E., and J. Stephan. Stapczynski. "Septic Abortion." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 682.</ref>		*Usually a polymicrobial infection<ref>Tintinalli, Judith E., and J. Stephan. Stapczynski. "Septic Abortion." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 682.</ref>

Ostermayer: Text replacement - "Category: OB/GYN" to "Category:OBGYN"

2016-03-22T14:23:36Z

Text replacement - "Category: OB/GYN" to "Category:OBGYN"

← Revisión anterior		Revisión del 14:23 22 mar 2016
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	<references/>		<references/>

	[[Category: ~~OB/GYN~~]]		[[Category:OBGYN]]

Rossdonaldson1 at 06:57, 28 September 2015

2015-09-28T06:57:27Z

← Revisión anterior		Revisión del 06:57 28 sep 2015
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	{{VB DDX greater than 20}}		{{VB DDX greater than 20}}

	==~~Workup~~==		==Diagnosis==
	*Clinical diagnosis; patient may be reluctant to share information that she had an unsafe abortion		*Clinical diagnosis; patient may be reluctant to share information that she had an unsafe abortion
	*Labs: CBC, blood type with Rh status, CMP, serum beta-hcg level, UA, blood cultures		*Labs: CBC, blood type with Rh status, CMP, serum beta-hcg level, UA, blood cultures
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	==Disposition==		==Disposition==
	Admit		*Admit

	==Complications==		==Complications==
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	*[[Vaginal Bleeding Pregnant (greater than 20wks)]]		*[[Vaginal Bleeding Pregnant (greater than 20wks)]]
	*[[Vaginal Bleeding Pregnant (less than 20wks)]]		*[[Vaginal Bleeding Pregnant (less than 20wks)]]
	==~~Sources~~==
			==References==
	<references/>		<references/>



	[[Category: OB/GYN]]		[[Category: OB/GYN]]

Rossdonaldson1: /* Vaginal Bleeding */

2015-09-28T06:56:42Z

Vaginal Bleeding

← Revisión anterior		Revisión del 06:56 28 sep 2015
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	{{Abdominal Pain Pregnancy DDX}}		{{Abdominal Pain Pregnancy DDX}}

	~~===[[Vaginal Bleeding]]===~~
	{{VB DDX greater than 20}}		{{VB DDX greater than 20}}