Aborto séptico por Clostridium perfringens complicado con shock séptico / Septic abortion due to Clostridium perfringens complicated with septic shock

ANTECEDENTES: La sepsis por Clostridios es una entidad poco frecuente que conlleva una mortalidad del 8090% a pesar del tratamiento antibiótico y quirúrgico. A pesar de que la mayoría de los casos de septicemia secundaria a Clostridios se originan en el aparato genital femenino tras un aborto séptico, solo un pequeño porcentaje de abortos sépticos (1%) se siguen de septicemia. CASO CLÍNICO: Gestante de 15 semanas que acude a urgencias por rotura prematura de membranas pretérmino. Ante el deseo de la paciente se mantiene actitud conservadora con antibioterapia iv, produciéndose a las pocas horas el aborto de forma espontánea junto con aparición de signos de infección. Rápidamente la paciente evoluciona a sepsis grave, y ante la sospecha de aborto séptico se efectúa histerectomía. Tras la intervención ingresa en situación de shock séptico con insuficiencia renal, hepática y respiratoria. Durante el ingreso se confirma Clostridium perfringens como agente responsable del proceso séptico. Finalmente la paciente es dada de alta definitiva tras seis meses, una vez resueltas las alteraciones derivadas del proceso séptico.

BACKGROUND: Clostridial sepsis is a rare condition which carries a mortality of 80-90% despite antibiotic and surgical treatment. Although most cases of septicemia due to Clostridium are originated in female genital tract after septic abortion, only a small percentage of septic abortions (1%) are followed by septicemia. CLINICAL CASE: Our case is about a 15 weeks pregnant woman attended the emergency room for preterm premature rupture of membranes. Due to the desire of the patient we proceed conservative treatment with antibiotics iv, in the following few hours the abortion develops spontaneously along with signs of infection. Rapidly the patient progresses into a severe sepsis, due to suspected septic abortion, the patient is intervened urgently by hysterectomy. After the intervention she enters into septic shock state with respiratory, kidney and liver failure. During the admission Clostridium perfringens is confirmed as a causative agent for septic process. Finally the patient is discharge after six months once resolved all complications arising from septic process.

Women with septic abortion: who, how and why? A prospective study from tertiary care hospital in India.

A prospective descriptive interview based hospital study was carried on 47 women admitted with septic abortion to evaluate their psychosocial, demographic and clinical profile These women were predominantly parous (75%), hindus (60%), between 20-30 years of age (60%) and mostly married (91.4%) house wives (63.8%). More than 90% already had one or more male child. The contraceptive use was dismally low (23.4%). Their knowledge about legalisation, place and persons authorized to conduct abortions was very less, however large majority (87%) underwent abortions within 3 months of pregnancy. Large family, poverty and spacing were the main reasons cited for abortions. Abdominal pain, fever, genital bleeding, diarhoea and abdominal distension were presenting clinical features in order of frequency. Advanced sepsis and associated medical and surgical complications were present in more than half the patients and 6% succumbed to these problems. The current experience was an eye opener for most of them and changed their future attitude. Hence education, economic prosperity, easy access to reproductive health facilities and institutional management of sepsis is the key to make abortions safe.

Glomerular hemodynamics during abortion induced by RU 486 and sepsis in rats

1. Acute renal failure is a very common consequence of septic abortion. Whole kidney and glomerular hemodynamics were evaluated in virgin (V), pregnant (PREG) and aborted (ABOR) euvolemic Munich-Wistar rats before and after E. coli (0111-B4) endotoxin (LPS) infusion in order to evaluate the effect of septic abortion on the renal microcirculation. 2. Abortion induced by RU 486 blunted the increase in glomerular filtration rate (GFR) induced by normal pregnancy (0.86 +/- 0.03 vs 0.63 +/- 0.07 ml/min, P < 0.05). In virgin rats, RU 486 did not modify the parameters of renal function. Significant alterations occurred in whole kidney and single nephron function. However, the changes in whole kidney function in the ABOR group were significantly higher than those observed for the V group (reductions in GFR were 42 in V and 80 in ABOR, RPF decreased 34 in V and 76 in ABOR, TRVR increased 82 in V and 400 in ABOR). 3. Mean single nephron glomerular filtration rate (SNGFR) was reduced in all groups after LPS (44 in V, 43 in V+RU, 55 in PREG, 60 in ABOR), due to significant decreases in glomerular plasma flow rate, QA (42 in V, 55 in V+RU, 53 in PREG, 57 in ABOR) and in glomerular ultrafiltration coefficient, Kf (46 in V, 47 in V+RU, 45 in PREG, 67 in ABOR). 4. These data show that LPS induced significant alterations in renal function in all groups. However, aborted rats were more sensitive to the effects of LPS than V rats. These results indicate that abortion may potentiate the effects of endotoxemia on renal function elevating the extent of acute renal failure and thus the mortality rate.

Conceptos actuales en la patogénesis y tratamiento del aborto y el choque séptico: Parte II. Bases fisiopatológicas y perspectivas en el manejo del choque séptico / Currente concepts on pathogenesis and treatment of abortion and septic shock: Part II. Physiopathologic bases and perspectives in the management of septic shock

El choque séptico (CHS) es un evento poco frecuente en las pacientes gineco-obstétricas, no obstante diversas condiciones como el aborto séptico, las corioamnioitis, y las infecciones puerperales pueden complicarse con este síndrome. Los problemas infecciosos representan cerca de 20 por ciento de las muertes maternas. Debido a la alta morbilidad que el CHS condiciona, es necesario tener un conocimiento actualizado del mismo. No obstante que cualquier individuo puede padecer una infección, la respuesta del hospedero a los microporganismos invasores es el punto crítico para el desarrollo del CHS. Múltiples evidencias han mostrado la importancia de las endotoxinas bacterianas y del factor de necrosis tumoral en la patogénesis de este síndrome. El manejo incluye: control de proceso infecciosos, mantenimiento de un aporte adecuado de 02 a los tejidos, uso de agentes inotrópicos y medidas de soporte general. El uso de anticuerpos monoclonales contra endotoxinas es la perspectiva de tratamiento más promisoria, aunque hasta el momento acutal no ha sido demostrada una eficacia real

Avances en la patogénesis y actualidades en el manejo del aborto y choque sépticos / Advances in the pathogenesis and treatment of the abortion and septic shock

El aborto séptico es un proceso infeccioso cuyo origen más frecuente es la realización de procedimientos abortivos de tipo ilegal. Las cifras reales de este problema en nuestro país no son bien conocidas, no obstante está bien definida su alta morbilidad y mortalidad. La amplia irrigación sanguínea y linffática de la placenta y del endometrio facilita la entrad de microorganismos durante el procedimiento abortivo, con desarrollo de bacteremia, diseminación de la infección y en algunas pacientes evolución al choque séptico. Múltiples evidencias han mostrado la importancia de las endotoxinas bacterianas y del factor de necrosis tumoral en la patogénesis del choque séptico. El manejo de esta patología incluye: control del poceso infeccioso, mantenimiento de un aporte adecuado de oxígeno a los tejidos, uso de agentes inotrópicos y medidas de soporte general. El uso de anticuerpos monoclonales contra endotoxinas es la perspectiva de tratamiento más promisoria de este síndrome, aunque hasta el momento actual no ha sido claramente demostrada su utilidad