1/8. Second trimester septic abortion and the Dalkon shield.The Dalkon shield was withdrawn from the market in the united states of America last year because of the reports of 11 maternal deaths and 209 cases of septic midtrimester abortions associated with the device in situ. Four cases of late midtrimester septic abortions resulting in neonatal deaths are presented. In one of these, the mother developed septicaemic shock and almost died. The true pregnancy rate with the Dalkon shield is much higher than was initially claimed, particularly if it is inserted in the puerperium. Surveys on the outcome of the pregnancy indicate that 50% end in spontaneous abortion and one in 20 pregnancies are ectopic. A high percentage of the abortions are septic. The Dalkon shield, therefore, has no advantages over other intrauterine contraceptive devices and it remains to be seen whether the recent modification of the device has overcome the disadvantages of the earlier version. If pregnancy is diagnosed with the device in situ, it should be removed if the string is visible. If pregnancy continues with the shield in place, the patient should be observed closely. Should septic abortion occur, active management is indicated and early evacuation of the uterus is recommended.- - - - - - - - - - ranking = 1keywords = abortion (Clic here for more details about this article) |
2/8. Toxic shock syndrome after laminaria insertion.BACKGROUND: laminaria tents used to facilitate surgical abortion are rarely associated with significant infectious morbidity. CASE: A parous woman in midpregnancy had laminaria placed in her cervix followed by a second set after 24 hours. Eight hours later, she presented with dyspnea, hives, fever, tachycardia, and hypotension. Antibiotic treatment was initiated and a dilation and evacuation procedure was performed. Amniotic membrane cultures showed a heavy growth of staphylococcus aureus with staphylococcal enterotoxin C expression, compatible with toxic shock syndrome. CONCLUSION: laminaria cervical dilation might be associated with toxic shock syndrome.- - - - - - - - - - ranking = 0.11111111111111keywords = abortion (Clic here for more details about this article) |
3/8. Toxic shock syndrome due to clostridium sordellii: a dramatic postpartum and postabortion disease.We describe a young woman who developed clostridium sordellii toxic shock syndrome after having had an abortion medically induced by mifepristone (RU-486; Mifeprex [Danco laboratories]) 7 days before admission to our hospital. Although the patient was aggressively treated, death occurred <3 days after admission. It is hoped that very early recognition of this disease will decrease the mortality associated with this rarely reported ailment that occurs among young, otherwise healthy women.- - - - - - - - - - ranking = 0.55555555555556keywords = abortion (Clic here for more details about this article) |
4/8. A fatal case of clostridium sordellii septic shock syndrome associated with medical abortion.BACKGROUND: Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. CASE: A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. CONCLUSION: The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.- - - - - - - - - - ranking = 0.77777777777778keywords = abortion (Clic here for more details about this article) |
5/8. Fatal toxic shock syndrome associated with clostridium sordellii after medical abortion.endometritis and toxic shock syndrome associated with clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.- - - - - - - - - - ranking = 0.77777777777778keywords = abortion (Clic here for more details about this article) |
6/8. Streptococcal toxic shock associated with septic abortion.The group A streptococcus is capable of producing exotoxins that have been linked to a toxic shock-like syndrome. Streptococcal toxic shock is a rapidly progressive disease associated with injury to multiple organ systems and a 30-60% mortality rate. We present a case of a 40-year-old woman who developed group A streptococcal toxic shock following a spontaneous abortion. She required surgical debridement, pulmonary artery catheterization, mechanical ventilation, and massive transfusions. Clinicians must be aware of the presentation of this disease, as its incidence appears to be increasing.- - - - - - - - - - ranking = 0.55555555555556keywords = abortion (Clic here for more details about this article) |
7/8. Fatal peritonitis following IUD-associated salpingitis.Previous reports have implicated the Dalkon shield intrauterine device (IUD) in septic second trimester abortion and maternal death from sepsis. In the case reported here, fusobacterium necrophorum, a rarely pathogenic vaginal anaerobe, gained access to the uterus in a woman wearing a Dalkon shield and caused acute parametritis, overwhelming peritonitis, systemic sepsis, and death. It is well known that IUDs can contribute to the development of serious pelvic infections, and in this case it is possible that the Dalkon shield was the cause of the ascending infection into the uterus.- - - - - - - - - - ranking = 0.11111111111111keywords = abortion (Clic here for more details about this article) |
8/8. Septic shock in a pregnant or recently pregnant woman.Septic shock may be classified clinically as primary (reversible) or secondary (irreversible). Primary shock is further distinguished as early ("warm-hypotensive") or late ("cold-hypotensive"). Infected abortion, chorioamnionitis, or pyelonephritis of pregnancy calls for appropriate measures directed toward preventing septic shock, including administration of huge doses of antibiotics. If septic shock ensues, extirpation of the nidus of infection becomes a primary consideration. Surgical extirpation should be carried out if possible, and as soon as possible. Besides antibiotics, patients with septic shock may require glucocorticoids, vasomotor drugs, digitalis, and heparin. Careful monitoring is essential.- - - - - - - - - - ranking = 0.11111111111111keywords = abortion (Clic here for more details about this article) |