misoprostol and Shock--Septic

Evidence suggests that restricting abortion does not reduce its occurrence but increases health risk. A qualitative analysis was performed, reviewing the medical charts of 12 women who died from unsafe induced abortions in Mexico City; most deaths occurred before abortion was decriminalized. Women resorted to using unsafe techniques, without medical guidance or under incorrect recommendations by providers, ultimately resulting in the loss of their lives. Postabortion care in private and public health facilities was often inadequate. The cases illustrate the importance of liberalizing abortion laws and improving postabortion care to protect the life and health of women seeking to terminate pregnancy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Fatal Outcome; Female; Humans; Mexico; Misoprostol; Patient Safety; Pregnancy; Quality of Health Care; Shock, Hemorrhagic; Shock, Septic; Young Adult

Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol-only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Adult; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Humans; Misoprostol; Pregnancy; Self Medication; Shock, Septic

To report a case of a healthy woman who was admitted to the hospital with septic shock caused by a common uropathogen after self-administration of misoprostol for pregnancy termination.. Case report.. Tertiary hospital.. A 38-year-old woman, gravida 5, para 3, who developed septic shock after medical termination of pregnancy.. Suction curettage, antibiotic treatment, plasma and platelet transfusions.. Klebsiella pneumoniae was isolated from blood samples.. Ten days after her admission she was discharged home in good condition on oral antibiotics.. Severe infections leading to septic shock from common pathogen bacteria can occur after medical termination of pregnancy, independently of the regimen used.

Topics: Abortifacient Agents; Abortion, Induced; Adult; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Misoprostol; Pregnancy; Self Administration; Shock, Septic

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Adult; Antibiotic Prophylaxis; Clostridium Infections; Clostridium sordellii; Fatal Outcome; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy in Diabetics; Shock, Septic; Young Adult

Group A Streptococcus is an aerobic gram-positive bacteria known to cause cutaneous infections. Invasive infections can lead to toxic shock syndrome with multiorgan failure and mortality rates of 25-48%.. A healthy, young woman developed necrotizing fasciitis, myonecrosis, and toxic shock syndrome after an elective medical termination of pregnancy. This patient had confirmed group A Streptococcus on blood cultures and underwent surgical debridement. After aggressive surgical treatment, below-the-knee amputation, and antibiotic therapy, the patient survived.. This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome.

Topics: Abortifacient Agents; Abortion, Induced; Amputation, Surgical; Fasciitis, Necrotizing; Female; Humans; Mifepristone; Misoprostol; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Young Adult

To better understand the risk of fatal toxic shock caused by Clostridium sordellii in women who had a recent medical abortion with mifepristone and misoprostol.. We performed active and passive surveillance for cases of toxic shock associated with medical or spontaneous abortion. To identify the cause of toxic shock, immunohistochemical assays for multiple bacteria were performed on formalin-fixed surgical and autopsy tissues. We extracted DNA from tissues, performed Clostridium species-specific polymerase chain reaction assays, and sequenced amplified products for confirmation of Clostridium species.. We report four patients with toxic shock associated with Clostridium species infection after medical or spontaneous abortion. Two women had fatal Clostridium perfringens infections after medically induced abortions: one with laminaria and misoprostol and one with the regimen of mifepristone and misoprostol. One woman had a nonfatal Clostridium sordellii infection after spontaneous abortion. Another woman had a fatal C sordellii infection after abortion with mifepristone and misoprostol. All four patients had a rapidly progressive illness with necrotizing endomyometritis.. Toxic shock after abortion can be caused by C perfringens as well as C sordellii, can be nonfatal, and can occur after spontaneous abortion and abortion induced by medical regimens other than mifepristone and misoprostol.. III.

Topics: Abortifacient Agents; Abortion, Therapeutic; Administration, Intravaginal; Bacterial Toxins; Clostridium Infections; Clostridium perfringens; Clostridium sordellii; Fatal Outcome; Female; Humans; Laminaria; Mifepristone; Misoprostol; Necrosis; Pregnancy; Shock, Septic; Uterus

On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol. Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada. All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome.

Topics: Abortifacient Agents; Abortion, Induced; Canada; Clostridium Infections; Clostridium sordellii; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Shock, Septic; United States

Topics: Abortifacient Agents; Adult; Clostridium; Clostridium Infections; Female; Humans; Mifepristone; Misoprostol; Shock, Septic; Vaginal Diseases

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Adolescent; Adult; Clostridium Infections; Clostridium sordellii; Diagnosis, Differential; Endometritis; Fatal Outcome; Female; Humans; Hypotension; Mifepristone; Misoprostol; Polymerase Chain Reaction; Pregnancy; Pregnancy Trimester, First; RNA, Ribosomal, 16S; Shock, Septic; Tachycardia; Uterus; Vomiting

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Spontaneous; Clostridium Infections; Clostridium sordellii; Endometritis; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Shock, Septic

Live E. coli were infused i.v. in cats to induce gastrointestinal mucosal injury and the gastric mucosa was exposed to bile and a luminal pH of 1. A gastric lesion index was calculated and intestinal injury was graded. The effects of i.v. methylprednisolone before and after induction of bacteremia were compared with those of intragastric misoprostol combined with i.v. superoxide dismutase (SOD) and catalase and with a control group. Methylprednisolone, but not misoprostol/SOD/catalase, significantly reduced the gastric lesion index (p less than 0.05). The duodenum/small intestine was significantly injured in 4/6, 2/6 and 4/6 cats in the misoprostol/SOD/catalase, methylprednisolone and control groups, respectively (NS). End gastric luminal pH was 3.9, 2.7 and 4.5 in the respective groups (p less than 0.05), with systemic arterial pH 7.15, 7.15 and 7.32 (NS). Mean arterial pressure and cardiac output were improved with methylprednisolone. Misoprostol/SOD/catalase reduced late hypotension. Pulmonary arterial pressure rose to c. 200% of basal in all groups. Methylprednisolone, but not misoprostol/SOD/catalase, thus protected the gastric mucosa from sepsis-induced gastric injury concomitant with reduced disappearance of protons from the gastric lumen, but did not significantly affect small-bowel damage. Hemodynamic responses were significantly improved in methylprednisolone-pretreated cats.

Topics: Acid-Base Equilibrium; Alprostadil; Animals; Anti-Ulcer Agents; Catalase; Cats; Drug Therapy, Combination; Escherichia coli Infections; Gastric Acidity Determination; Gastric Mucosa; Hemodynamics; Hydrogen-Ion Concentration; Intestinal Mucosa; Methylprednisolone; Misoprostol; Multiple Organ Failure; Shock, Septic; Stomach Ulcer; Superoxide Dismutase

An experimental model was used which includes intragastric instillation of 80 mM HCl and 0.6 ml bile/kg followed by intravenous infusion of live E coli in cats for up to three hours. This procedure regularly induces gastric mucosal ulcerations. Mucosal blood flow was measured by microspheres before, early, and late in sepsis. Total gastric blood flow was recorded electromagnetically. Mucosal regeneration capacity as reflected by the RNA/DNA ratio was measured. Misoprostol (a PGE1 analogue) was infused iv (5 micrograms/kg X h) or given locally in the stomach (10 micrograms/kg) before bacteriemia. Misoprostol did not influence the haemodynamic response to bacteria. The gastric mucosal damage was assessed either as an index representative for the entire corpus-fundus region or as the number of areas with intact surface epithelium within the series. Misoprostol iv protected the mucosa from ulceration compared with untreated septic controls while misoprostol intragastrically significantly reduced the number of damaged areas only. Topical misoprostol increased total gastric and mucosal blood flows early in sepsis compared to iv or no pretreatment while no difference was seen during late sepsis. The protective effect of misoprostol was thus not dependent on increased gastric mucosal blood flow. Nor was it mediated through effects on mucosal nucleic acid concentrations or ratio.

Topics: Animals; Cats; Disease Models, Animal; Gastric Mucosa; Hemodynamics; Misoprostol; Nucleic Acids; Prostaglandins E, Synthetic; Regeneration; Regional Blood Flow; Shock, Septic; Stomach Ulcer

Topics: Animals; Cats; Disease Models, Animal; Gastric Mucosa; Misoprostol; Prostaglandins E, Synthetic; Regional Blood Flow; Shock, Septic; Stomach Diseases; Superoxide Dismutase