This document presents a case study of a 27-year-old woman admitted with septic shock following an unsafe abortion attempt. She underwent an abortion procedure at a local hospital and developed severe abdominal pain, fever, and vomiting. She was referred to multiple hospitals and her condition deteriorated further, with symptoms of sepsis and multiple organ dysfunction. Upon admission, she was in septic shock. Laboratory findings showed signs of infection and organ failure. She underwent surgery which found pelvic abscesses. She received intensive care including ventilation, antibiotics, and organ support. Her condition gradually improved with treatment but she continued to have respiratory issues. The case demonstrates the dangers of unsafe abortion and importance of proper infection prevention and management of septic abortion and shock
1. SEPTIC ABORTION : WHERE
WE STAND (CASE
PRESENTATION)
Dr Subhrata Nanda
2. Mrs S C, age 27yrs, from Puri admitted in
labour room at 1am on 5/5/17 during
emergency hours with complain of pain
abdomen, vomiting, loose motion, yellow
discolouration of body and eyes &
decreased urination with reddish
discolouration of urine since last 3 days
3. She is G4 P3 L3 at 19 wks of gestation
went to a local hospital at Niali for MTP
and MTP was tried . After 24hrs on 3/5/17
pt developed severe abdominal pain which
subsided within 2hr without any
medication. Then pt was referred to
another hospital in Bhubaneswar where
evacuation was done at 10pm on 3/5/17.
There perforation was detected by the
surgeon and pt was put on conservative
management.
4. On 4/5/17 pt developed pain & swelling of
abdomen, jaundice, oliguria. She was
referred to Hi-Tech medical college where
she was diagnosed as septic shock in low
condition. Due to unavailability of ICU, pt
was referred here.
5. PATIENT CONDITION ON
ADMISSION
Pt was toxic, tachypnoeic, pale, icteric,
pulse 130/min feeble, BP 80/40
mmhg, RR 30/min
On P/A it was tense, tender, guarding
+, rigidity +, bowel sounds sluggish
On P/S vulval edema +, with muddy
discharge, foley’s catheter insitu with
50ml of haemorrhagic urine
On P/V Ut 16wks, soft and tender
6. Pt was shifted to ICU and pt condition
deteriorated (fall in SpO2 urine output
nil for 12hrs). USG done and the
diagnosis ?uterine perforation, pelvic
collection with B/L acute medical renal
disease and B/L moderate pleural
effusion. Decision for laparotomy was
done to rule out bowel perforation.
Laparotomy was done at 4pm on
5/5/17 in presence of surgeon.
7. Intra operative findings
There was 200ml of yellowish dirty
collection. No bowel perforation
detected. There was a broad ligament
hematoma on right side of size 5X
4cm. Uterus contour was intact. B/L
tubes and ovaries healthy. Hematoma
was drained and peritoneal lavage
was done and intra peritoneal drain
was left. Pt shifted back to ICU
8. LAB FINDINGS ON ADMISSION
Hb- 7.4 gm%
PCV – 22%
T wbc – 21000/ cc
TPC- 70000/cc
PT- 22.2(↑)
aPTT- 95.9(↑)
INR- 1.32
Fibrinogen – 508
mg/dl
Urea- 86mg/dl
Creatinine- 2.3mg/dl
Serum billirubin-
9.3mg/dl , D-
6.2mg/dl
LFT- raised
CBC notes- toxic
change +, shift to left
+
Culture from urine,
blood and peritoneal
fluid shows no
growth. Tracheal
culture shows
Acenobacter
10. MANAGEMENT
Pt was in ICU
Pt was on mechanical ventilation,
crystalloids, Inotropes, BT, FFP, Platelet,
Dialysis and broad spectrum antibiotics
and other supportive measures.
Then pt gradually improving and
intraperitoneal drain was removed on
15/5/17 and extubated on 16/5/17 and
due to shortness of breath on 17/5/17
she was on NIV.
11. CLINICAL FINDINGS ON
17/5/17
Pt is conscious and oriented and
catheterized and on central venous line
Dyspnoeic and on NIV
Anaemic, no icterus, B/L pedal edema
Vitals-pulse-134/min
BP-149/84mmHg without
ionotrops
RR-46/min
Temp-99.5F
P/A-soft, parietal edema on flanks, BS
present, wound healthy
15. SEPTIC ABORTION-Any abortion associated with
clinical evidences of infection of the uterus and its
contents is called septic abortion.
SEPTIC SHOCK/ENDOTOXIC SHOCK-Hypotension
(systolic BP <90mm Hg) is due to sepsis resulting in
derangements in cellular and organ system function.
Hypotension persists in spite of adequate fluid
resuscitation. Associated typically with septic abortion,
chorioamnitis, pyelonephritis and rarely postpartum
endometritis.
16. Clinical criteria of septic abortion
1. Rise of temperature of atleast
100.4ºF (38.4⁰C) for 24 hours or
more.
2. Offensive or purulent vaginal
discharge.
3. Other evidences of pelvic infection –
like lower abdominal pain and
tenderness.
17. Mode of infection
80% cases source of infection is
endogenous
Micro-organisms responsible are :
a) Anaerobic – Bacteroides group , Cl.
Welchii, Anaerobic streptococci
b) Aerobic – E.coli ,klebsiella, Staph ,
psuedomonas , MRSA
25. PRINCIPLE OF MANAGEMENT OF
SEPTIC SHOCK
Appropriate supportive care
Correction of hemodynamics
Broad spectrum antibiotics
Correction of acidosis
Remove the source of sepsis
26. INDICATIONS OF SURGERY
Injury to uterus
Suspected bowel injury
Presence of FB in abdomen
Unresponsive peritonitis suggestive of
collection of pus
Septic shock not responding to
conservative t/t
Uterus is too big to be safely
evacuated vaginally
27. PREVENTION
Strengthening family planning
practices
Rigid enforcement of legalized
abortion in practice and to curb the
prevalence of unsafe abortion
Proper antiseptic and aseptic
measures
28. KIND REQUEST ON BEHALF
OF SOCIETY
THINK TWICE BEFORE SAYING
NO
BECAUSE
A NO TODAY MAY FORCE YOU
TO
THINK EVERYDAY