Historical perspective on septic abortion
Dear Dr. Zelop:
The article “Sepsis and Septic Shock in Pregnancy” in the June 2018 issue was informative. I thought you would be interested, at least for historical perspective, in the experience at Los Angeles County-USC Medical Center in the 1950-1960 era. At that time septic abortion was by far the most common and severe form of pregnancy infection, especially with complications of generalized sepsis, septicemia, endotoxin shock, renal shutdown (acute cortical necrosis) and vascular collapse.
Until our protocols were developed, at least one fatality per month occurred at that facility. Most of the techniques were employed as described in the contemporary article, including diagnosis-usually very easy-then vascular support, very aggressive antibiotics, antitoxin and steroids, removal of infected tissue (early) and “peritoneal dialysis.”
Enclosed herein is a 1963 paper from the Green Journal from LA County-USC Medical Center by the late and great Gail Anderson, first full-time chief of OBGYN at LA County-USC Medical Center and me, on a special subset caused by clostridium welchii organism. Early removal of infected tissue by hysterectomy, peritoneal dialysis, antitoxin along with antibiotics all were necessary to lower the incidence of morbidity and mortality.
Another paper referenced in this article described the more “usual” septic abortion (E. coli, etc). Of course, since Roe v Wade these medical problems are much reduced, although principles of diagnosis, treatment, etc. described in your article are very beneficial.
The clash between “right to choose” and “right to life” has powerful arguments on both sides. Perhaps more effective, cheaper and safer contraception will help solve the medical, economic, and moral dilemmas on both sides.
Marshall Kadner, MD
Dear Dr. Kadner:
Thank you for sharing your historical perspective with our readership regarding septic abortion. I would like to take this opportunity to acknowledge the significant clinical contributions to women’s health care made by providers like you who work so diligently in the trenches.