Occasional Review: Septic Abortion with Endotoxic Shock

Abstract

Endotoxic shock is a syndrome resulting from sepsis due to gram-negative bacteria. The most common organisms involved are Escherichia coli, Aerobacter aerogenes, Proteus mirabilk or vulgaris and Pseudomonas aeruginosa. Endotoxic shock in the young patient is relatively rare. When it does occur it is usually in association with pregnancy. The most common cause is septic abortion, but it is also seen with chorioamnionitis and pyelonephritis. In 1956, Studdiford and Douglas first drew attention to "acute circulatory collapse" in association with septic abortion. The incidence of endotoxic shock with septic abortion vanes from 2.5% to 6.4% (Douglas and Beckman, 1966;Weil et al., 1964).Although few cases of endotoxic shock are seen by the average obstetrician-gynaecologist, the problem is of vital importance for 2 reasons ( 1 ) there is a high mortality (2) there is a difference of opinion on management.The mortality in endotoxic shock vanes from 1 1 % to 82% (Coleman, 1964;Shubin and Weil, 1963). The mortality statistics will, of course, depend upon the type of patient, the method of treatment, and how early the diagnosis is made.Endotoxic shock with septic abortion should be associated with a relatively good prognosis in so much as (a) the patients are young and have a firm grasp of life, (b) they have a removable septic focus, and (c) they respond well to treatmant. Despite these facts, the death toll of patients with septic abortion and endotoxic shock remains high, the reported incidence being from 22% to 70% (Studdiford and Douglas, 1956;Douglas and Beckman, 1966).