SEPTIC MISCARRIAGE

Is a miscarriage that take place as result of infection do to the present of microorganism in the body of the patients, Often septic miscarriage are cause by sexually transmitted infection. i.e Gonorrhoea etc.

GENERAL MEASURES 

Counselling the patient.

And then urgent evacuation of uterus and surgical management of the complications should be carried on the patient.

 

MEDICINE TREATMENT

1. Oxytocin, IV (intramuscular).
2. Dilute 20 units in 1 L sodium chloride 0.9%, i.e. 20milliunits/mL solution administered at a rate of 125 mL/hour.
3. Reduce rate if strong contractions are experienced.

Antibiotic therapy 

4. Ampicillin, IV, 1 g immediately, followed by 1 g 6 hourly.

PLUS

5. Gentamicin, IV, 6 mg/kg daily. PLUS
6. Metronidazole, IV, 500 mg or oral, 400 mg 8 hourly.

 

Change to oral treatment after clinical improvement:

7. Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 7–10 days.

 

Note: The addition of metronidazole to amoxicillin/clavulanic acid is unnecessary as amoxicillin/clavulanic acid has adequate anaerobic cover.

 

Penicillin allergy:

8. Clindamycin, IV, 600 mg 8 hourly. PLUS
9. Gentamicin, IV, 6 mg/kg daily.

 

Change to oral treatment after improvement:

10. Clindamycin, oral, 450 mg 8 hourly for 5 days.  PLUS
11. Ciprofloxacin, oral, 500 mg 12 hourly.

 

If patient has severe sepsis, consider urgent hysterectomy.

 

REFERRAL

When the patient is experiencing the following condition, it should refer to specialist immediately;

1. Evidence of trauma.
2. No response to treatment within 48 hours