{
    "abstract": "The pathophysiology of abortion induced by the transcervical introduction of compounds containing mixtures of soap, cresol and phenol is complex. A plan is necessary for the treatment of such critically ill women. The complex, multisystem damage produced by those compounds requires an extremely sophisticated treatment approach to avoid the many pitfalls that beset those cases.\nA review of the prelegal abortion scene in the US precedes discussion of the effect of injected soap, phenol, cresol, and their compounds. The latter is based on a review of 4 toxicology books. There is little difference in the symptoms after the instillation of phenols, cresols, or soaps. Any one of those agents can cause vaginal bleeding, abdominal pain and distension, nausea, vomiting, and cramps. The damage produced by the use of Lysol thus is due to both the phenol and soap components of the compound. Following instillation into the uterus, there is coagulation necrosis of the decidua and placental site. The toxin will invariable cause thrombosis of the intrauterine and parametrial veins. The thrombosis may spread to the entire pelvic vein plexus and paravaginal, paracervical, and ovarian veins. The liver and kidney are affected by the toxin. Icterus and bile pigments in the urine and clinical evidence of liver damage are seen often. Pulmonary edema has been described as have microscopic to massive pulmonary oil emboli and thrombosis. Depression of all bone marrow elements due to toxin has been reported. The red blood cells are further depressed in number because of hemolysis. Cerebral changes include oil emboli, cerebral coagulation, necrosis, and petechial hemorrhages. Until Studdiford and Douglas described gram-negative sepsis causing shock, patients admitted with hypotension accompanying septic abortion were thought to have concealed blood loss. Studdiford and Douglas showed that gram-negative septicemia could produce hypotension. With the advent of massive antibiotic therapy for septic abortion and septic shock, most of these patients could be saved. The kidneys, after exposure to phenolic-soap comounds, show mainly lower nephron changes. As long as the toxin is in the system those changes continue until irreversible renal damage occurs. It is essential to remove the source of the poison (the affected uterus) and then remove the circulating toxins. the main problem is removal of the circulating toxin. In addition to the problems produced by fixed and circulating toxin, it has been shown that most phenol-soap induced abortions are infected. Thus it is necessary to employ the optimal antibiotic therapy for septic incomplete abortion. The initial management phase moves along classic lines. First is monitoring the vital state and supporting the systems. This includes maintaining an intravenous solution with a large-bore needle, monitoring central venous pressure, measuring urinary output, monitoring the vital signs, maintaining adequate oxygenation, and supporting the blood pressure with blood vasopressors or other agents, as needed. Second is diagnosing the extent of the illness. Third is the initial treatment, which includes reestablishment of the blood volume with blood transfusions; aggressive coverage with double or triple antibiotic therapy; correction of hypofibrinogenemia with cryoprecipitate, fresh whole blood or fresh frozen plasma, as indicated; and avoidance of overhydration in the presence of actual or suspected renal failure. After antibiotic coverage has been established, removal of retained products of conception is indicated.",
    "authors": [
        {
            "affiliation": null,
            "firstname": "M S",
            "initials": "MS",
            "lastname": "Burnhill"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": null,
    "journal": "The Journal of reproductive medicine",
    "keywords": [
        "Abortifacient Agents",
        "Abortion, Drug Induced--complications",
        "Abortion, Illegal--complications",
        "Abortion, Induced--complications",
        "Abortion, Septic--complications",
        "Abortion, Soap Solution--complications",
        "Americas",
        "Antibiotics",
        "Developed Countries",
        "Developing Countries",
        "Diseases",
        "Drugs",
        "Family Planning",
        "Fertility Control, Postconception",
        "North America",
        "Northern America",
        "Pregnancy Complications",
        "Products Of Conception, Retention",
        "Treatment",
        "United States",
        "Vacuum Aspiration"
    ],
    "methods": null,
    "publication_date": "1985-08-01",
    "pubmed_id": "4045835",
    "results": null,
    "title": "Treatment of women who have undergone chemically induced abortions.",
    "xml": "<Element 'PubmedArticle' at 0x7885035bae30>"
}