Unsafe Abortion: The Silent Endemic; An Avoidable Cause of Maternal Mortality. A Review

Unsafe abortion (UA) is still a main cause of maternal mortality in countries with restrictive abortion laws. Our objective was to review current concepts about septic abortion (SA), its epidemiology, diagnosis, management and prevention. A wide variety of methods for inducing abortion exist. Lastly, misoprostol has replaced more dangerous methods. Septic abortion is a polymicrobial ascending infection. It should be suspected in any young women presenting with lower abdominal pain, fever and vaginal bleeding, as well as with severe sepsis or septic shock. Broad-spectrum antibiotics and source control should be initiated promptly. Removal of retained products of conception should be performed as soon as possible. Indications for laparotomy are failure to respond to uterine evacuation and adequate treatment, uterine perforation with suspected bowel injury, pelvic and adnexal abscesses and clostridial myometritis. Indications for hysterectomy are a uterus of woody appearance or discolored, clostridial necrotizing myometritis, crepitation of the pelvic tissue and radiographic evidence of air within the uterine wall. Aggressive surgical wound debridement and hysterectomy should be performed whenever gas gangrene is present. Effective contraception has been shown to reduce UA but is not enough to cope with high fertility regulation demands. Legalized, safe and accessible abortion services are required.