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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

33 women with severe infection of the genital tract were studied using fastidious anaerobic techniques. The women, admitted to the Department of Obstetrics and Gynecology at Cook County Hospital were referred to the Infectious Disease Service for the following: pelvic abscesses (13), tubo-ovarian abscesses (3), endometritis following dilatation and currettage (2), sepsis associated with incomplete abortion (7), puerperal sepsis (5), vaginal abscess (1), vulval abscess (1), and Bartholin's gland abscess (1). Anaerobic bacteria was cultivated from all 33 patients. Aerobic bacteria was associated with anaerobes in 21 patients, the most frequent isolate being E. coli, followed by facultative streptococci of the viridans group. 12 patients had only anaerobes present but no patients had aerobes in the absence of anaerobic forms. 12 patients also has positive blood cultures for the same anaerobes isolated from soft tissues. The 3 groups of anaerobes isolated with greatest frequency were bacteroides, peptostreptococci and clostridia. Bacteroides fragilis was the major species recovered in 26 specimens. 6 patients who had failed on conventional antibiotics were treated with clindamycin, a new antibiotic with high activity against anerobes. All patients responded satisfactorily. These bacteriologic and clinical observations suggest that anaerobes play an important and often decisive role in serious pelvic infections.
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PMID:Anaerobic infections of the female genital tract: bacteriologic and therapeutic aspects. 458 19

132 physically health patients (aged 12-41 years; 12-21 weeks gestation) were given intraamniotic PGF2alpha (prostaglandin F2alpha) for induction of midtrimester abortion. Analgesic agents and antiemetics were administered intramuscularly as needed. The patients were grouped as follows: 1) Group A (n=48), those who were given an initial dose of 25 mg PGF2a, then as needed; 2) Group B (n=43), initial dose of 30 mg, 25 mg at hour 6-8, and 25 mg at hour 24; 3) Group C (n=17), initial dose of 40 mg, subsequent 40 mg if unaborted at hour 24; and 4) Group D (n=24), initial dose of 40 mg, 10-25 mg at hour 6-8, additional 20 mg if unaborted at hour 24. A 94.7% incidence of abortion was achieved. In Group A, 29 had complete abortion, 16 incomplete, and 3 failures. Group B had 32 complete abortions, 8 incomplete, and 3 failures. Group C had 9 complete, 7 incomplete, and 1 failure. Corresponding figures for Group D were 19, 5 and 0 respectively. Average time to abortion ranged from 13 hours 22 minutes to 25 hours 33 minutes. The primary side effects of PGF2a were gastrointestinal (vomiting, diarrhea). 70% of patients vomited and 13.6% became febrile. Serious complications included sepsis, systemic reaction to prostaglandin, and cervical laceration. Advantages of intraamniotic PGF2a include ease of administration; generally short injection-abortion time; and its ability to induce myometrial contractions regardless of gestational size. However, the safety, convenience, and acceptability of PGF2 are yet to be established. The following guidelines are suggested for minimizing complications: 1) a test dose of 2.5 mg should be administered slowly over at least 1 minute, 2) fever should not be attributed to drug reaction but considered as suggestive evidence of developing infection, 3) patients unaborted at hour 24 should be considered as high risk with respect to potential failure to abort, development of infection, or cervical laceration, and 4) cervical inspection should be performed, especially in the nulliparous patient with a later gestation and a long labor.
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PMID:Experience with intra-amniotic prostaglandin F2 alpha for abortion. 474 58

A study is presented of 126 women, aged 16-46, who died after undergoing illegal abortions, The number of deaths caused by abortions has fallen between 1947-1973. Of these 126 cases, 75 of the women were married, and 89 were between 21-35; 68 had no children. This would seem to contradict the assumption that the average woman seeking abortion is young, unmarried, or already married with too many children. The most frequent reasons given for abortion among the married women were the number of children and extramarital conception. Among the unmarried women, most sought abortion because the father was already married or had disappeared. 8 of the 75 unmarried women, 27 of the 28 single women, and 3 of the 9 widowed women were employed. The male responsible for the pregnancy seems to have had a significant influence in the decision to seek and abortion. 82 of the abortions occurred in the 2nd-5th months of pregnancy. 55 of the cases involved a 3rd person who performed the abortion; in 14 cases the abortion was self-induced. 23 of the aboritons were performed by experienced abortionists. 36 patients died due to venous air embolisms, 28 due to sepsis, 15 due to peritonitis, and 9 due to soap poisoning, which were the most frequent causes of death. 75 of the 126 deaths led to court cases. It is concluded that a liberalization of the law concerning legal abortion would not reduce the death rate due to illegal abortion or solve any other problems caused by increased fertility.
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PMID:[Fatalities after interruption (author's transl)]. 484 59

296 nonhospital abortions using an abortifacient paste method are examined in support of the outpatient abortion. Patients ranged in age from 11 to 47 years, 20% were married, and 98% were in the poverty or lower income level. The patients were seen at 2 1/2 months gestation. Under sterile conditions in a doctor's office 10-40 cc of a high viscosity paste - potassium neutral soap with KI and thymol, borne in a multitincture menstruum - was admitted by syringe into the internal os. The method paralleled the Luenbach paste method but abrasives were absent. The paste impaired circulation between zygote and chorion frondosum. On the 2nd day ergotrate was given. Flow lasted 3-7 days. There was frequent follow-up by phone. Check-up vaginals were done at 1 and 3 weeks. 78% had excellent results. 11% needed 2-3 weeks treatment with carbazochrome salicylate, vitamin K, or medrozyprogesterone acetate. 3% required dilatation and curettage. The 6% failures should be considered operator failures in misjudging length of gestation. Sepsis, serious complications, or fatality were absent with this method. Preliminary history omitted cases from this method that might preclude complications. The success with these cases indicates that the nonhospital, paste-induced abortion can be both effective and safe.
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PMID:Looking back at Luenbach: 296 non-hospital abortions. 491 44

To alleviate crowding in the gynecological wards, 350 of 410 cases of incomplete abortion seen between February and July, 1969, were treated as outpatients with analgesia instead of anesthesia. Patients with sepsis, severe anemia, septicemia or hypovolaemic shock, or who aborted as a result of serious illness were treated as inpatients. 74.4% of the patients were discharged within 12 hours. Paracervical block in combination with pethidine and valium administered intravenously or premedication with pethidine was more effective than paracervical block alone.
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PMID:Management of incomplete abortion as an outpatient procedure. 511 99

Federal government policy in the United States lacks uniformity, as is indicated by the fact that the Dept. of Defense permits the performance of abortion for medical and mental health reasons, the Office of Economic Opportunity states that no project funds may be used for any surgical procedure intended to result in abortion, and the Dept. of Health, Education and Welfare has no policy concerning abortion in its programs but that abortion is a reimbursable expense under Title XIX Medicaid payments in enrolled states. This ambiguity of the federal government is considered a reflection of the complexity of the issue and the lack of clear consensus concerning abortion among the American public. Factors that federal family planning officials must consider are: 1) the ethical and moral considerations that confront the individual citizen making a private decusion about abortion; 2) legal and constitutional issues, such as that of discrimination in the availability of abortion services on economic grounds; and 3) the relationship of abortion to public service needs and public health considerations, given that 1/4-1/5 of pregnancies in the United States end in legal or illegal abortion. Clandestine abortion constitutes a significant health problem, accounting for a significant proportion of maternal mortality, especially among the poor (the 1967 rate of reported mortality due to abortion with sepsis being 7 times greater for nonwhites than whites). The Office of Economic Opportunity in reassessing its current policy needs to ascertain the standards of medical care, cost projections, and logistics of providing abortion services. It is recommended that abortion services be combined with serious efforts to provide effective subsequent contraception, as abortion as an exclusive method of birth control would cost up to $2000 per year while the provision of high quality family planning services is $60-$80 per woman per year.
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PMID:United States government policy on abortion. 514 90

The authors present 2 cases of post-abortion psychosis and discuss the etiology of this complication from the literature. Psychosis after abortion is rare, estimated at 0-1% in 2 studies, and 6 cases in 15 years experience of 32 psychiatrists in another. The suggestion that illegal abortion is more likely to precipitate psychosis is based in part on the greater possibility of gas embolism and consequent neurologi c lesions. Neurologic symptoms such as sensory, motor, pyramidal and ex trapyramidal signs and epileptic crises could results from scar tissue in the central nervous system. The first patient was a 31-year old mother of 1 illegitimate daughter, in conflict with her partner about having the abortion. After attempting abortion with soap solution she was hospitalized for coliform shock and sepsis complicated by gastric ulcers. 3 weeks alter she became psychoitic, with alternating aggressio n, exhibitionism, infantile behavior and catatonia. After release from the hospital she committed suicide. The second patient had marital conflicts, related to fear of pregnancy, and narcicistic desire for consumer goods instead of children. After she became pregnant with an IUD in place, the abortion commission, at first ambivalent, granted abortion, which required 2 curretage procedures. She had delerium and paranoia concerning her 5 abortions. The authors remarked that the trau ma of abortion may precipitate pscyhosis in a disturbed personality with inner or outer conflicts; it is impossible to predict when decompensation might occur, even if the pregnancy is carried to term.
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PMID:[2 cases of post-abortion psychoses]. 546 32

The woman with complications of chemical abortion (often induced by soap or Lysol solution) is a prototype of the critically ill surgical patient. Usual mortality where hysterectomy is delayed or not done is 60%. 5 such patients, all with sepsis and uterine necrosis were treated by hysterectomy. All had renal failure, 4 required dialysis; 1 underwent diuresis after injection of ethacrynic acid. Major complications, in addition to renal failure, were pulmonary. 2 patients who had prophylactic vena-cava clips and ligation of ovarian veins escaped pulmonary complications. All patients survived without physiologic disturbances.
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PMID:Management of septic chemical abortion with renal failure. Report of five consecutive cases with five survivors. 580 22

Since the majority of patients requesting induced abortion are nulliparous, it is important that the procedure not endanger future fertility. Infection and uterocervical trauma are 2 possible abortion-related complications which might affect furture fertility. A clinical study was conducted to assess the efficacy of prophylactic use of an antibiotic as a routine accompaniment of induced abortion. Patients selected for the study had been accepted for elective 1st-trimester abortion under the 1967 British Abortion Act. All were aborted with intrauterine extraamniotic PG(prostaglandin) administration supplemented by curettage. 142 of the women received no prophylactic; 145 received 1200 mg metronidazole by mouth 2 hours before the procedure and 400 mg 3 times daily for 2 days thereafter. Population characteristics in the 2 groups were comparable. 24% of the nonantibiotic group as compared to only 4% of the antibiotic group developed postoperative pyrexia. 12% in the nonantibiotic group as compared to 2% of the antibiotic group developed vague symptoms suggestive of pelvic sepsis or of incompleted evacuation. There was no evidence of cervical or uterine trauma in either group. It is concluded that prophylactic antibiotics should be administered with pregnancy termination procedures.
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PMID:Metronidazole and prostaglandin induced abortion. 611 49

Records of adolescent girls in Nigeria admitted to the gynecologic ward of the University of Benin Teaching Hospital from 1974-79 show that abortion accounted for 28% of gynecologic admissions in Nigeria. In a review of 244 cases, 60.8% of the patients were adolescent girls and 53.7% of them had septic abortions. 37.5% of the authors' patients already had 1-3 induced abortions or live births at the time of admission and yet had no knowledge of contraception. Only 16.8% were attended by physicians, 9.8% were self induced. The most common complications were hemorrhage, sepsis, cervical laceration, and hypovolemic shock. The main causes of severe morbidity and mortality were uterine and bowel perforation, peritonitis, and endotoxic shock. Several studies indicate that unsuccessful illegal induced abortion is one of the main causes of death among unmarried Nigerian girls of school age, who are ignorant of and lack access to contraception. 2.8% of illegal abortions in this series resulted in death compared to 11% in 1963-67 in Lagos. 62.5% of abortion-related deaths occurred in adolescent girls and 20% of all female adolescent deaths in the entire hospital. Morbidity and mortality associated with adolescent induced abortion are extraordinarily high in Nigeria compared with the U.K., Denmark, and Sweden. The Federal Government of Nigeria is urged to liberalize the abortion law and to provide basic sex education and family planning for adolescent boys and girls in order to discourage criminal abortion and its attendant complications.
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PMID:Adolescent induced abortion in Benin City, Nigeria. 612 34


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