A 30-year-old woman presents two days after an abortion performed at an unregistered facility. She has fever of 39 degrees C, foul-smelling vaginal discharge, lower abdominal tenderness, and a soft bulky uterus with an open cervical os. Blood pressure is 100/60 mmHg. What is the first step in management?
- A Immediate suction evacuation of the uterus
- B Intravenous broad-spectrum antibiotics followed by uterine evacuation once she stabilizes ✓
- C Oral doxycycline and metronidazole with outpatient review in 48 hours
- D Total hysterectomy with bilateral salpingectomy
Correct answer: B. Intravenous broad-spectrum antibiotics followed by uterine evacuation once she stabilizes
Explanation
Septic abortion is treated initially with high-dose intravenous broad-spectrum antibiotic cover, typically a penicillin or cephalosporin combined with metronidazole and gentamicin, because sepsis must be controlled before instrumentation. Evacuation of retained infected products follows once the patient is stabilizing. Immediate evacuation risks bacteremia and perforation of a softened uterus, oral outpatient therapy is inadequate with hypotension, and hysterectomy is reserved for refractory sepsis or clostridial gangrene of the uterus.
Reference: Williams Obstetrics, 26th ed.
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