Conditions · Obstetrics and gynecology
Septic and unsafe abortion !
A septic abortion is a uterine infection after a pregnancy loss or an unsafe abortion. It can lead to sepsis and death and needs urgent care.
Updated 2026-11-01
Structures involved
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Why it happens
What it is
Infection of the uterus and its contents during or after a spontaneous or induced abortion, which can spread to the pelvis and the bloodstream. Unsafe abortion is ending a pregnancy by people without the needed skills or in an environment that does not meet minimum medical standards, and it is the main cause of septic abortion.
Who gets it
The WHO estimates that around 45% of abortions worldwide are unsafe and that unsafe abortion is an important preventable cause of maternal death and disability, most of it in low- and middle-income countries. In Colombia, the Constitutional Court allowed voluntary termination of pregnancy (IVE) in three situations in 2006 (sentence C-355) and decriminalised it up to 24 weeks in 2022 (sentence C-055); access to safe services and post-abortion care remains uneven, especially in rural areas.
Causes
- Retained products of conception that become infected
- Instruments or substances introduced into the uterus in unsafe conditions, causing infection or perforation
- Usually polymicrobial: vaginal and bowel flora, anaerobes and Escherichia coli
- Less often but very dangerous: Clostridium species (including tetanus), group A Streptococcus
Risk factors
- Abortion performed by untrained people or with non-sterile methods
- Incomplete abortion with retained tissue
- Delay in seeking care because of stigma, legal fear or distance
- Untreated sexually transmitted infection or bacterial vaginosis
- Adolescence, poverty and lack of access to contraception
- Later gestational age at the time of abortion
Pathophysiology
Retained necrotic tissue and blood in the uterine cavity are an ideal medium for bacteria from the vagina. Infection starts in the decidua and endometrium (endometritis) and can spread to the myometrium, tubes, parametria and peritoneum. Toxin-producing organisms can cause rapid haemolysis, tissue necrosis and septic shock with DIC. Uterine perforation can injure the bowel or bladder.
Classification
- Endometritis limited to the uterus
- Spread to the adnexa and parametria (pelvic infection)
- Pelvic peritonitis or generalised peritonitis
- Sepsis and septic shock with organ failure
Symptoms and signs
- Fever and chills days after a pregnancy loss or abortion
- Lower abdominal or pelvic pain
- Vaginal bleeding and foul-smelling discharge
- Uterine and cervical motion tenderness; cervix may be open with visible tissue
- Tachycardia and general malaise
Diagnosis
- Clinical
- Based on history of a recent pregnancy loss or abortion (the woman may not disclose an induced abortion) plus fever, pelvic pain and purulent or foul discharge. Speculum and bimanual examination look for an open cervix, retained tissue, injury and tenderness. Care is confidential and without judgement.
- Tests
- Pregnancy test and quantitative hCG, complete blood count, blood and endocervical cultures, lactate, kidney and liver function, coagulation tests and blood group with Rh status.
- Imaging
- Pelvic ultrasound to look for retained products, collections or a foreign body. Abdominal radiograph or CT when perforation, free air or an abscess is suspected.
Differential diagnosis
- Incomplete abortion without infection
- Ectopic pregnancy
- Pelvic inflammatory disease
- Acute pyelonephritis
- Acute appendicitis
Goal of treatment
Resuscitate and treat sepsis quickly, start broad-spectrum antibiotics, remove the source of infection by evacuating the uterus, manage complications and offer respectful post-abortion care and contraception.
Treatment
- Acute
- Sepsis bundle: intravenous access, fluids, cultures, lactate and early antibiotics; vasopressors and intensive care for septic shock.
- Medical
- Broad-spectrum intravenous antibiotics covering Gram-negative, Gram-positive and anaerobic organisms (for example, clindamycin with gentamicin, or ampicillin with gentamicin and metronidazole); tetanus prophylaxis when indicated; anti-D immunoglobulin for Rh-negative women.
- Procedure
- Prompt uterine evacuation, preferably by manual or electric vacuum aspiration, once antibiotics have started.
- Surgical
- Laparotomy for uterine perforation, bowel injury or abscess; hysterectomy when the uterus is necrotic or infection is not controlled.
- Follow-up
- Nursing priorities: vital signs, urine output and mental status for early signs of shock; bleeding; pain control; confidential and non-judgemental care; counselling and contraception before discharge.
Complications
- Septic shock and multiorgan failure
- Disseminated intravascular coagulation and acute kidney injury
- Uterine perforation with bowel or bladder injury
- Pelvic abscess and septic pelvic thrombophlebitis
- Hysterectomy, intrauterine adhesions and infertility
- Maternal death
Prognosis
Early treatment, source control and antibiotics usually lead to full recovery. Delayed care, toxin-producing organisms or perforation carry high mortality. Survivors may have chronic pelvic pain, adhesions or reduced fertility.
Prevention
- Access to modern contraception and comprehensive sexuality education
- Access to safe abortion within the legal framework (in Colombia, the IVE framework)
- Timely, confidential post-abortion care for all women with complications
- Contraception counselling and supply after any abortion
Test yourself
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What are the two pillars of treatment in septic abortion?
Early broad-spectrum antibiotics and evacuation of the uterus (source control), together with sepsis resuscitation.
What is the preferred method to evacuate the uterus?
Vacuum aspiration (manual or electric).
Which organisms are typical?
Polymicrobial vaginal and bowel flora, including anaerobes and E. coli; Clostridium species are rare but severe.
Under the 2022 Colombian Constitutional Court ruling, up to what gestational age is abortion decriminalised?
Up to 24 weeks, with the three earlier legal grounds still applying after that.
What should be offered before discharge?
Contraception counselling and a method, anti-D immunoglobulin if Rh-negative, and follow-up.
Related conditions
- Miscarriage (early pregnancy loss)
- Sepsis and septic shock
- Ectopic pregnancy
- Pelvic inflammatory disease
- Disseminated intravascular coagulation
- Acute kidney injury
- Asherman syndrome (intrauterine adhesions)
- Tetanus
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Abortion (World Health Organization, 2024); Statement on maternal sepsis (World Health Organization, 2017).
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