A 24-year-old woman presents at 10 weeks gestation with heavy vaginal bleeding and severe cramping. On examination, the cervical os is open and products of conception are visible in the cervical canal. Ultrasound shows retained products in the uterus. Which is the most appropriate immediate management?

• A Surgical evacuation (vacuum aspiration) ✓
• B Medical management with misoprostol 600 mcg sublingually
• C Expectant management for 2 weeks
• D Intravenous oxytocin infusion

Explanation

The patient has an incomplete abortion with open os, heavy bleeding, and retained products on ultrasound. Surgical evacuation (vacuum aspiration) is the treatment of choice in hemodynamically unstable patients or with heavy bleeding, as it rapidly removes retained tissue and achieves hemostasis. Misoprostol can be used in stable patients with minimal bleeding, but with active heavy bleeding, surgical evacuation is preferred. Expectant management is inappropriate with significant hemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.