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# 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

Tap one to see what it is and open it in 3D.

- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Uterine tubes](https://durgical.com/en/anatomy/uterine-tube/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)
- [External os](https://durgical.com/en/anatomy/external-os-of-uterus/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)

## Why it happens

- [How septic shock develops](https://durgical.com/en/general-pathology/how-septic-shock-develops/)

## What it is

Infection of the uterus and its contents during or after a spontaneous or induced abortion, which can spread to the [pelvis](https://durgical.com/en/anatomy/region/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](https://durgical.com/en/anatomy/vagina/). Infection starts in the decidua and [endometrium](https://durgical.com/en/anatomy/endometrium/) (endometritis) and can spread to the [myometrium](https://durgical.com/en/anatomy/myometrium/), tubes, parametria and [peritoneum](https://durgical.com/en/anatomy/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

## Red flags

- Hypotension, confusion, cold extremities or low urine output (septic shock)
- Jaundice, dark urine or bleeding from puncture sites (haemolysis, DIC)
- Rigid [abdomen](https://durgical.com/en/anatomy/region/abdomen/) or signs of peritonitis (possible perforation)
- Air or a foreign body seen on imaging
- Heavy bleeding with signs of hypovolaemia
- Trismus or muscle spasms (tetanus)

## 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](https://durgical.com/en/anatomy/cervix-of-uterus/), 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](https://durgical.com/en/anatomy/kidney/) and [liver](https://durgical.com/en/anatomy/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

Think of the answer, then tap the question to see it.

## 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.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/septic-and-unsafe-abortion/)

## Related conditions

- [Miscarriage (early pregnancy loss)](https://durgical.com/en/conditions/miscarriage/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/)
- [Disseminated intravascular coagulation](https://durgical.com/en/conditions/disseminated-intravascular-coagulation/)
- [Acute kidney injury](https://durgical.com/en/conditions/acute-kidney-injury/)
- [Asherman syndrome (intrauterine adhesions)](https://durgical.com/en/conditions/asherman-syndrome/)
- [Tetanus](https://durgical.com/en/conditions/tetanus/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Abortion](https://www.who.int/news-room/fact-sheets/detail/abortion) (World Health Organization, 2024); [Statement on maternal sepsis](https://www.who.int/publications/i/item/WHO-RHR-17.02) (World Health Organization, 2017).

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Source: https://durgical.com/en/conditions/septic-and-unsafe-abortion/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/septic-and-unsafe-abortion/