[Postabortal staphylococcic septicemia complicated by cervical osteomyelitis with quadriplegia; presentation of the cured patient].
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Placenta accreta is defined as a condition involving an abnormal adherence of the placenta to the myometrium. It is rare for placenta accreta to present before 20 weeks' gestation; only eight cases have been previously reported. This case report describes a first-trimester placenta accreta which presented during suction curettage for missed abortion. The major risk factors for placenta accreta are related to previous uterine trauma. Considering the rising rate of operative births in the United States, it is possible that the incidence of placenta accreta in early gestation will increase.
A paracervical abscess occurred after paracervical block anesthesia was administered for induced abortion in an 18-year-old multigravida. She presented with vaginal, low abdominal and low back pain and with nausea, vomiting, chills and fever. Incision and drainage of the abscess were performed and a vaginal drain inserted under antibiotic coverage. Cultures of the abscess contents revealed multiple anaerobic organisms. Laparoscopy showed normal pelvic organs, and the peritoneal fluid cultures were negative. Postoperatively the patient became afebrile and was discharged after three days on antibiotics. To our knowledge, this case report is the first one on paracervical abscess as a complication of induced abortion with paracervical block anesthesia.
As the result of the study carried out by the authors, a conclusion has been made on the leading role of polymicrobial aerobic-anaerobic complexes, capable of producing a synergic effect, in the etiology of endometritis, anaerobic microorganisms prevailing in their importance. In the etiology of endometritis the most important organisms are bacteroids and peptostreptococci among anaerobes, enterobacteria and group D streptococci among aerobes. Anaerobic bacteria causing endometritis are most sensitive to dalacin and lincomycin, least sensitive to benzylpenicillin, resistant to aminoglycosides. The amounts of aerobic and anaerobic microflora contaminating the uterine cavity correlate with the severity of endometritis.
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Septic pelvic thrombophlebitis is an uncommon complication in obstetrics and gynecology that may be difficult to diagnose clinically. Computed tomography (CT), an accurate and noninvasive modality, has greatly aided in the diagnosis of this disorder. In a case of septic pelvic thrombophlebitis complicating second-trimester pregnancy termination, CT enabled the correct diagnosis to be made and treatment to be initiated.
Examination of the uterus cavity microflora in 50 patients with endometritis post abortum revealed that the etiology of endometritis post abortum was polymicrobial and its development was mainly due to aerobic and anaerobic microbial associations. By the isolation frequency enterococci predominated among the aerobic organisms and bacteriods and fusobacteria predominated among the anaerobic organisms. All the pathogens isolated from the uterus cavity were characterized by polyresistance to antimicrobial drugs. The aerobic bacteria were often resistant to the antibiotics active against the anaerobic organisms which required the use of combined antibacterial therapy in some cases.
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