Septic Abortion Managed in a Tertiary Hospital in West Bengal

Abstract

Background: Septic abortion is still a challenging problem and a major cause of maternal mortality and morbidity in developing countries.

Aim: The present study was conducted to estimate incidence, causes, risk factors, associated microorganisms, and treatment modalities of cases of septic abortion managed in a tertiary health care in West Bengal.

Subjects and Methods: It was a cross‑sectional study carried out in Burdwan Medical College and Hospital in West Bengal between July 2011 and June 2012. On admission a thorough history was taken, examination was done, and investigations were carried. Depending on the examination findings the cases were grouped into three grades‑grade I: The infection localized in the uterus; grade II: The infection spread beyond the uterus to the parametrium, tubes, and ovaries or pelvic peritoneum; grade III: Generalized peritonitis and/or endotoxic shock or jaundice or acute renal failure. Statistical analysis was done by using Epi Info™ software (Version 3.5.1, CDC) after proper arrangement of all the data in tabular form and presented as simple percentage.

Results: During the period, 1297 cases of abortion were admitted among which 107 were septic abortions, thus giving the incidence of the latter as 8.2% (107/1297). Forty‑three percent cases of septic abortion (46/107) were in grade I, 21.5% (23/107) in grade II, and 35.5% (38/107) in grade III. The modal age group of the patients was 15‑25 years (49.5%). Majority of the subjects were married (77.6%; 83/107) and multiparous (60.7%; 65/107). Similarly, most of them (71%; 76/107) were from low socioeconomic class. Ninety percent of the patients (96/107) had induced abortion. The common clinical features at presentation were pallor (88.8%; 95/107) and fever (86.0%; 92/107). Escherichia coli (62.6%; 67/107) and Klebsiella pneumonia (32.75%; 35/107) were the most common organism isolated. The case fatality from septic abortion in this study was 13.1% and the condition accounted for 15.4% of total maternal mortality within the period reviewed.

Conclusion: The incidence of septic abortion in this study is relatively high, and majority of the cases resulted from attempted termination of pregnancy. It is a significant contributor to maternal mortality. Promotion of family planning and legalization of abortion services will go a long way in reducing the incidence of septic abortion and its
associated complications.

Keywords: Asia, management, maternal mortality, outcome, septic abortion