|Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)|
|CHAPTER 6 - MANAGEMENT OF SEPSIS|
With sepsis, prompt definitive treatment of the source of infection can be life-saving. Retained products of conception is most often the source of infection. The infection may have spread, and there may be more than one source of infection. Consider the possibility of intra-abdominal injury, pelvic abscess, peritonitis, gas gangrene, or tetanus. ALL sources of infection must be treated. In addition, if the woman has an IUD in place, it should be removed.
Retained products of conception is often a source of infection. Uterine evacuation is an essential treatment for ALL women who are at risk for septic shock who also have an incomplete abortion. See Chapter 3. If evacuation is NOT possible, then refer the woman once initial stabilizing steps have been taken. Intra-abdominal injury, pelvic abscess, and peritonitis MUST be treated promptly, and surgery is often required. For treatment of an intra-abdominal injury, see Chapter 5.
If the woman is bleeding from several sites and the bleeding is not easily stopped, quickly assess the patient for disseminated intravascular coagulation (DIC), a bleeding disorder (coagulopathy) that can be seen with severe cases of sepsis. Signs of DIC include:
· bleeding from oral mucosa (inside the mouth), bladder, injection site, or venipuncture site
· blood in the urine
· failure of patient's blood to clot (in the laboratory tube or on floor)
· decreased platelet count
· fragmented red blood cells under microscopic exam.
If DIC is suspected, immediately treat the sources of infection; evacuate the uterus without delay. Transfusion of fresh whole blood or plasma will help. If DIC becomes apparent or persists after uterine evacuation, antibiotics, and fluid resuscitation, continue IV fluids and give heparin 5,000-10,000 units IV every six hours if available. Refer the patient to a tertiary care centre.
Suspect gas gangrene if x-ray shows gas in the pelvic tissue. Suspect tetanus if the woman has painful muscle contractions, generalized spasms and convulsions. After initial stabilizing efforts, antibiotics, tetanus antitoxin and sedation (to control convulsions in the case of tetanus) have been started, promptly refer to a tertiary care centre. If the woman goes into shock, it should be treated as outlined in Chapter 2.