Artificial community-acquired (criminal) miscarriage

All cases of unsafe abortion, including in this number and miscarriages late pregnancy, regardless of body temperature patients when they come to the hospital, should be considered as infected, for any artificial intervention with the aim of ladojskaya performed outside the hospital environment, of course, accompanied by infection. The largest number of community-acquired infected miscarriages late in their pregnancy have on pregnancy at 16 to 20 weeks, which is 55% of the total number of patients (I. M. kostrukova). Most women with an infected miscarriage happens feverish condition; bacteriological examination of the blood often detect pathogenic microorganisms.
Feverish abortion is in a group of infected miscarriages prominent place. The frequency of febrile flow of abortions, which began outside the hospital varies in rather wide limits. However, increased body temperature is not an absolute indicator of the clinical severity of the case (fever and septic miscarriage). Often there are cases when at normal body temperature condition of the patient is still very hard and treatment is unsuccessful.
The infection of a woman's body the main role belongs to the microorganisms which get in the genital tract from the outside. Microorganisms listed with external genital parts deep into the vagina, penetrate the cervical canal in the uterine cavity.
Regular pathogens septic infection in febrile abortion first place is occupied by Streptococcus and Staphylococcus. There are indications that mortality from abortions when infection with Streptococcus twice more than in infections by Staphylococcus and by Escherichia coli; mortality rate in haemolytic streptococcal infection is significantly higher than the infection non-haemolytic Streptococcus.
The cause of sepsis with the criminal abortion is often anaerobic streptococci, which penetrate the upper divisions sexual apparatus causes severe clinical picture of septic abortion (thrombophlebitis with cancer, jaundice, bleeding in the fundus of the eye, purulent inflammation of the peritoneum and fiber; from anaerobic infections gas-forming bacilli have a special place (A. Hoffman).
Clinic anaerobic infection when abortion is characterized by the presence of the following triad of symptoms:
1) getuserinfo color of the skin;
2) brown, almost black in the urine and
3) a reddish-brown color of blood serum.
But for the infection is still not enough that the microorganisms have been made into sexual apparatus. The growth and spread them occur only with the weakening of immunobiological properties sex channel and resilience (reactivity) the whole body. In the case of an infected (criminal) abortion conditions conducive to weakening of protective forces, always include: 1) the prolonged bleeding from the genital tract contributes to the change in the reaction of the vaginal environment from acidic to alkaline; as a result of this change and properties of microorganisms that normally acidic environment of the vagina, die (the purification of the vagina); 2) the long-term unveiled the cervical canal of the uterus in connection with nezakonchitsya abortion contributes to the implementation of infection from the vagina into the uterus; 3) the remains of the ovum into the uterine cavity - a breeding ground for the introduction and growth of microorganisms; 4) the wound surface of the uterus is the entrance gate for promotion of infection outside it; 5) prolonged bleeding weakens the body's defenses.
Thus, women with an infected miscarriage has all opportunities for development as a local disease sexual apparatus (metroendometrit, inflammation of the uterus, pelvic peritoneum and fiber), and for General distribution of infection by blood and lymphatic ways (peritonitis, sepsis). In some cases, these symptoms of the illness is not come, which means good protective reactions of the organism in established infection. In the development of infection in miscarriage to distinguish three stages:
1) infection breeds only in eggs (egg infection);
2) infection has passed on the wall or even on the vessels of the uterus (neaicina infection);
3) the infection has spread beyond the uterus and moved to adjacent organs of small pelvis or even generalisability (infection outside the uterus). It is clear that as long as the source of infection is within the ovum, valid any intervention for a quick recovery of the patient. A completely different line of conduct must be at infection, has captured the uterus and passed beyond it.
Clinical forms. Division of miscarriages on febrile and septic (Mueller, Melnikov and others) are not sufficient, as these concepts do not determine the clinical picture. So, feverish believe miscarriages in which septic no symptoms and only a high fever and signs of miscarriage. Septic called miscarriages, in which the infection has gone beyond the uterus and there are clear signs of generalized sepsis (chills, dry tongue, sometimes jaundice, thrombophlebitis, presence of metastases, bacteria in the blood and others).
Such classification would be correct if bacteriological point of view was taken division infection petridou and septic. However, attempts of this division infection rejected. From a clinical point of view, such a classification is incorrect because there is never absolute confidence in that feverish miscarriage not already in septic, as it is not always clinically (for lack of absolute objective evidence), you can tell exactly went whether the infection outside of the uterus.
Currently, it is customary to distinguish between:
1) uncomplicated infected miscarriage (infection breeds within the uterus);
2) complicated infected miscarriage (infection has spread outside of the uterus, but the process is local);
3) septic abortion (infection is generalized character - septicaemia, pyemia).
When assessing the clinical picture in each case, along with the other symptoms, you need to consider the temperature, pulse rate, the opening of the cervix (impassable or traversed the cervical canal), the nature of vaginal discharge (brownish, putrid, or purulent, viscous or tar-like consistency).
On this basis, that the infected miscarriage is often criminal, it is recommended to inspect the cervix in mirrors to detect traces of a possible intervention.