How do you know if you have a post-abortion infection?

Infections following medical abortions are very rare. If you feel weakness, nausea, vomiting, diarrhea, fever that lasts more than 24 hours or is higher than 100.4 F/ 38 C, pain in your belly, if your belly feels sore or tender, if you bleed a lot or for a long time, or if you have vaginal discharge that smells bad, you might have an infection and you should go to a doctor immediately. The infection should be treated with antibiotics.

A fever that starts soon after Misoprostol administration and lasts less than 24 hours and is less than 100.4 F/ 38 C is a common side effect. If the fever lasts longer than 24 hours or is greater than 100.4 F/38 C, you should seek medical attention.

Medical abortion is a safer alternative in places where surgical methods are dangerous for a woman’s health, or in places where the availability of safe abortion is restricted. The risk of infection is greater when a woman has a child than when she has a medical abortion.

More scientific information:
“Post-abortion infection is not well defined as one particular type of infection in studies of medical abortion ³³. The most common type of infection reported is endometritis, which is an infection of the lining of the uterus, and genital tract. It may involve infection of reproductive organs and the urinary system. Clostridium sordellii sepsis is another type of post-abortion infection that is extremely rare. Doctors analyzed one case in which a woman died from complications associated with Clostridium sordellii infection, and determined that even though the infection was associated with medical abortion, the case “does not alter the overall proven safety of medical abortions induced with Mifepristone and Misoprostol ¹¹. Clostridium sordellii can also cause fatal infections in women who have just given birth ³⁹. It is not an infection that only affects women having medical abortions.

Clostridium sordellii specifically called attention to the somewhat unusual and rather distinctive signs and symptoms associated with these infections — an absence of fever but the presence of refractory hypotension, hemoconcentration, effusions in multiple serous cavities, and dramatic leukocytosis. A Canadian woman died in 2001 of the same bacterial infection under similar circumstances. Disturbing aspects of the cases described by Fischer et al. in this issue of the Journal (pages 2352–2360) include the following: all the women were young and healthy; they had apparently successful procedures (there was no evidence on autopsy of retained products of conception); their clinical presentations were somewhat cryptic because they had cramping, which is very common after the procedure, and no fever; and they all died remarkably rapidly after presentation. As tragic as the deaths of these young, healthy women are, they remain a small number of rare events without a clear pathophysiologic link to the method of termination. Patients should be informed of this risk before they consent to the procedure and should be vigilant for symptoms after the procedure. ⁶²

“Most medical abortion studies have reported no infections, although a few have mentioned isolated cases ²⁶. 10 cases of infection were reported out of 80,000 women who had medical abortions using Mifepristone in the United States ¹⁵. A group of researchers reviewed many medical studies and concluded, “Infection after medical abortion procedures is an infrequent event, occurring in <1% of over 46,400 cases, substantially lower than the frequency of infection after surgical abortion ³³. They also stated, “… the overall frequency of reported infection after medical abortion procedures (0.92%) is lower than that reported after either surgical abortion procedures or childbirth ³³.

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