A 23-year-old woman presents with fever of 39 degrees Celsius, foul smelling purulent vaginal discharge and lower abdominal tenderness five days after an unsafe abortion performed by an unqualified practitioner. Pulse is 110 per minute and the uterus is soft and tender. What is the correct initial management?
- A Immediate dilation and curettage before any drug therapy
- B Methylergometrine orally with outpatient follow up
- C Broad spectrum intravenous antibiotics followed by evacuation of the uterus ✓
- D Total abdominal hysterectomy as the first step
Correct answer: C. Broad spectrum intravenous antibiotics followed by evacuation of the uterus
Explanation
Septic abortion is managed with parenteral broad spectrum antibiotic cover first, followed by prompt evacuation of retained products, because retained tissue perpetuates infection. Curettage before adequate antibiotic cover risks bacteraemic spread. Hysterectomy is exceptional, considered only for refractory sepsis with gas forming clostridial myometrial involvement or perforation. Simple oxytocics with observation are inadequate since the source of sepsis, retained products, remains in situ.
Reference: DC Dutta Textbook of Obstetrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.