Gas gangrene in pregnancy, parturition, and abortions requiring urological and surgical intervention: aetiopathogenesis, risk factors, and some current practices

Introduction: Gas gangrene in pregnancy, perinatal periods, or after an abortion has a poor prognosis. This study aims to present risk factors for the disease as reported worldwide and to discuss current concepts of its aetiopathogenesis.

Materials and Methods: Using search terms, a bibliographical search was done in PubMed/ Medline and PubMed Central databases for publications on gas gangrene in pregnancy, abortions, and delivery published within the study period. Risk factors for the disease were identified by studying each of the reports. Results were presented with a discussion of the aetiopathogenesis of the disease.

Results: Eighty-one (81) studies reporting on 67 patients and aetiopathogenesis of the disease were studied. The most common causes of the disease were clostridia which infected 63 (94.03%) of the patients. Identified risk factors were abortions, prolonged labor, prolonged obstructed labor, standard spontaneous vaginal delivery, Cesarean sections, episiotomy, amniocentesis, cordocentesis, ruptured uterus with fetal death, perforated appendix, pelvic tumors, trauma, foreign bodies in living tissues, accumulation of hematoma and devitalized tissues in pelvic tissues. Lethal effects of the pathogens were reported to be mediated by exotoxins produced by clostridia. 

Conclusion and Recommendations: Common risk factors are standard diagnostic and therapeutic procedures in pregnancy and its outcome. Local policies need to be developed for the extended use of antibiotics in normal labor and when carrying out procedures in pregnancy, delivery, and abortions. Attractive points in the aetiopathogenesis for the prevention of the disease are (i) prevention of attachment of clostridia to tissue cells and (ii) pre-pregnancy immunization of women of childbearing age.