From the Guidelines
Post-abortion fever is primarily caused by infections, with endometritis being a significant contributor, as evidenced by the association between bacterial flora and post-procedure infections 1. The causes of post-abortion fever (PAF) can be multifaceted, including:
- Infectious causes such as endometritis, retained products of conception that become infected, pelvic inflammatory disease, wound infections at the surgical site, and urinary tract infections
- Non-infectious causes like hematometra, pulmonary embolism, or drug reactions It is crucial to note that the risk of post-abortion infection is higher with certain factors, including incomplete abortions, prolonged procedures, pre-existing infections, or poor aseptic technique, as suggested by the increased risk of postoperative infectious complications associated with bacterial vaginosis (BV) 1. The use of prophylactic antibiotics before abortion procedures can significantly reduce infection risk, with metronidazole being a recommended option for anaerobic antimicrobial coverage, as it has been shown to substantially reduce postabortion PID in randomized controlled trials 1. In terms of management, treatment typically involves broad-spectrum antibiotics, and patients should be advised to avoid certain activities to prevent introducing bacteria into the healing uterus. Fever developing within 24-72 hours post-abortion warrants prompt medical evaluation to determine the cause and appropriate treatment, which may include surgical evacuation of any retained tissue if present.
From the Research
Causes of Post-Abortion Fever (PAF)
The causes of post-abortion fever (PAF) can be attributed to various factors, including:
- Infections, such as endometritis, urinary tract infections, wound infections, or phlebitis 2
- Pelvic infection, which can be caused by the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, or anaerobic organisms characterizing bacterial vaginosis 3
- Infective complications following induced abortions, which can be reduced by administering prophylactic antibiotics 4
- Medical abortion regimens, although the frequency of infection after medical abortion is very low (0.92%) 5
Risk Factors
Certain factors can increase the risk of post-abortion fever, including:
- Presence of lower genital tract infections, such as Chlamydia trachomatis or bacterial vaginosis 3
- History of cesarean delivery, which can increase the rate of endometritis 2
- Regional variations in diagnosis and treatment standards for infection 5
Prevention and Treatment
Strategies to prevent and treat post-abortion fever include:
- Administering prophylactic antibiotics to reduce infective complications following induced abortions 4, 3
- Screening for lower genital tract infections and treating positive cases 3
- Using diagnostic modalities, such as computed tomography, ultrasonography, and surgical exploration, to identify and treat underlying infections 2