1. Arch Gynecol Obstet (2007) 275:117–119
DOI 10.1007/s00404-006-0233-0
O RI G I NAL ART I C LE
Septic abortion: a review of social and demographic
characteristics
Henry Osazuwa · Michael Aziken
Received: 24 June 2006 / Accepted: 4 August 2006 / Published online: 1 September 2006
© Springer-Verlag 2006
Abstract Septic abortion is a signiWcant health prob- subsequent increase in the risk of ectopic pregnancy
lem with short- and long-term complications that aVect and infertility, it signiWcantly contributes to maternal
the quality of life of those fortunate enough to avoid death [4, 11]. Any society with a high fertility rate, low
mortality. Both spontaneous and induced abortion can contraceptive usage and legal obstacles to safe termina-
result in septic complications, with the latter dispropor- tion of pregnancy exposes women to an intricate web of
tionately higher. Its incidence is high in environments factors with potentially adverse consequences. Clini-
with restrictive abortion laws, as clandestine proce- cally recognizable spontaneous abortion complicates
dures by non-doctors in unhygienic settings are preva- about 15% of all pregnancies [3], while induced abor-
lent. This study shows that it is still more common tion, which remains a method for fertility regulation,
among teenagers and mainly performed by health pro- represents a staggering 30–60 million pregnancy losses
fessionals, which means that health care interventions annually [16].
should be re-evaluated and appropriately directed to A diverse group of organism is implicated including
preserve the reproductive health status of this vulnera- Escherichia coli, Klebsiella species, Proteus species,
ble population. Group B beta-haemolytic streptococcus, staphylococcal
organisms, Bacteriodes species, Neisseria gonorrhoeae,
Keywords Abortion · Pelvic sepsis · Contraception · Chlamydia trachomatis, Clostridium perfringens, and
Maternal mortality Mycoplasma hominis [12, 13]. Two major factors
contribute to the development of sepsis: the presence
of retained products of conception due to incomplete
Introduction spontaneous or induced abortion and the introduc-
tion of infection into the uterus from septic proce-
Septic abortion is an important problem in many dures, which can spread beyond the pelvis causing
resource-poor settings, with a prevalence as high as septicaemia.
86% [2]. Apart from damage to the fallopian tubes with Adolescents constitute a signiWcant proportion, as
they face unique barriers from obtaining safe abortion.
They are slower to recognize and accept the pregnancy
and are less likely than older and more experienced
H. Osazuwa women to know where to seek advice and help [1].
Department of Obstetrics and Gynaecology,
They are more likely to avoid the physician’s fee,
Igbinedion University Teaching Hospital,
Edo State, Nigeria thus exposing themselves to ineVective methods [10].
Added to these is the need to remain in school and fear
H. Osazuwa (&) · M. Aziken of social reprisal arising from out-of-wedlock pregnan-
Department of Obstetrics and Gynaecology,
cies [9]. Increasingly in areas with high fertility, older
University of Benin Teaching Hospital,
PMB 1111 Edo State, Nigeria women want smaller families and greater control over
e-mail: drhenryosazuwa@yahoo.co.uk the timing of their births. These women are at a risk of
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2. 118 Arch Gynecol Obstet (2007) 275:117–119
unwanted pregnancies and induced abortion if their One hundred and Wfty-six (59.1%) were between the
family planning needs are not met. ages of 16 and 19 years, which accounted for an over-
In places where abortion laws are restrictive, diVer- whelming majority of the patients. The age distribution
ent clandestine outlets exist for providing these ser- is depicted in Table 1. As shown in Table 2, most of the
vices by doctors and other professional group such as induced abortion was by dilatation and curettage, 174
mid-wives and nurses. These poorly supervised proce- (85.3%). The remaining was through artiWcial rupture
dures involve the use of contaminated instruments, of foetal membranes, 27 (13.2%), which was the pre-
methods that induce incomplete abortion, the insertion ferred method in gestational ages ¸18 weeks. We
of a hygroscopic cervical dilators or uterine syringing noted in three cases where a trans-cervical introduction
with chemicals designed to induce incomplete abor- of a Foley’s catheter was done. Majority of the
tion. Untrained senior family members or local village patients, 192 (72.7%), had antibiotic coverage and
women may also insert foreign bodies into the cervix evacuation of retained products of conception, while
using things such as bones, tree bark and sticks [5]. An there were 13 mortalities attributed to acute renal fail-
abortion case has even unsuccessfully tried induced ure, pulmonary oedema, hepatic encephalopathy and
abortion with agents such as salt, alum, potash often severe anaemia (Tables 3, 4).
consumed with drugs and alcohol [14]. Although it In 33 (16.2%) cases, the status of the abortion pro-
maybe expensive and not readily available, some doc- vider was not mentioned (Fig. 1). Medical doctors and
tors provide services in spite of its illegality in private nurses accounted for 102 (50.0%) and 69 (33.8%),
clinics with the same degree of safety as in resource- respectively. Figure 2 describes the pattern of contra-
abundant environments. ceptive usage. The majority, 204 (77.3%), used no con-
The objectives of this study were to determine the traceptive method. Forty-eight (18.2%) post-coital pill,
population at risk for septic abortion, deWne abortion while 12 (4.5%) were practising rhythm method.
providers and evaluate the pattern of contraceptive
usage. Outlining these characteristics will aid in allo-
Table 1 Age distribution
cating some preventive eVorts.
n %
·16 12 4.6
Materials and methods 16–19 156 59.1
20–24 36 13.6
The study was carried out in the University of Benin 25–29 24 9.1
¸30 36 13.6
Teaching Hospital. Medical records of patients admit- Total 264 100.0
ted and managed for septic abortion, over a 4-year
period, extending from June 2001 to May 2005, were
reviewed. Information on the age, parity, educational Table 2 Methods of induced abortion and average gestational
and marital status, occupation, nature of preceding age (GA)
abortion, abortion provider, contraceptive awareness n % Average GAa
and usage was extracted for review. Microsoft Excel
software was used for data analysis. Dilatation and curettage 174 (85.3) 10.2
Rupture of foetal membrane 27 (13.2) 18.1
Foley’s catheter insertion 3 (1.5) 16
Total 201 (100.0%) –
Results a
Gestational age in weeks
The total number of patients admitted and managed
for septic abortion was 288, out of which 264 case notes Table 3 Management of cases of septic abortion
were available for analysis with a retrieval rate of Intervention n %
91.7%. Two hundred and four (77.3%) and 60 (22.7%)
a
have induced and spontaneous abortion, respectively, ERPC/antibiotics 192 72.7
Exploratory laparotomy 14 5.3
preceding the sepsis. The majority of patients were nul- Evacuation of pelvic abscess 6 2.3
liparous, 216 (81.8%) and 191 (72.7%) were single. Repair of uterine perforation 5 1.9
One hundred and forty-four (54.5%) had a history Repair of bowel perforation 2 0.7
of previous induced abortion. Most of the patients had Hysterectomy (gangrenous uterus) 1 0.4
Only medical therapy 58 22.0
secondary education 129 (72.7%). Primary and tertiary
a
education was 48 (18.2%) and 24 (9.1%), respectively. Evacuation of retained products of conception
123

3. Arch Gynecol Obstet (2007) 275:117–119 119
Table 4 Intensive care unit (ICU) admission and mortality the health care providers contribute signiWcantly to
Intensive Maternal exposing these women to septic complications by pro-
care unit mortality viding services in unhygienic environments like homes,
(ICU admission) chemists’ shops and poorly equipped private clinics [7].
This trend towards neglecting the reproductive health
Septic shock/acute renal failure 7 4 (3)
Pulmonary oedema 4 3 (1) of their client is further highlighted by the use of foetal
Hepatic encephalopathy 1 2 (1) membrane rupture and in three instances the insertion
Electrolyte imbalance 3 – of a Foley’s catheter through the cervical os at gesta-
Acidosis 2 – tions more than 16 weeks. These methods are likely to
Hypokaleamia 1 –
Disseminated intravascular 1 – induce incomplete abortion and subsequent sepsis.
coagulation Septic abortion is more common following unsafe
Severe anaemia 3 5 (1) induced abortion with an excessive risk among teenag-
ers who are single with health professionals contribut-
ing signiWcantly as providers. Interventions must be re-
Fig. 1 Status of abortion not stated evaluated to oVer a more general outreach and the
provider 16% involvement of healthcare professional is invaluable.
doctors
50%
nurses
34%
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