A 24-year-old G2P1 underwent an unsafe induced abortion at 6 weeks. Three days later she has fever of 39 degrees C, foul-smelling vaginal discharge, pulse 120 per minute, and a tender uterus enlarged to 10 weeks size with the os open. After starting broad-spectrum parenteral antibiotics, what is the next essential step?

• A Delay evacuation until she is apyrexial for 48 hours
• B Total abdominal hysterectomy
• C Prompt evacuation of retained products of conception ✓
• D Oral misoprostol alone and outpatient review

Explanation

Septic abortion is almost always caused by retained infected products acting as a nidus; antibiotics alone will not clear the source, so evacuation follows promptly once antibiotics are running. Deferring evacuation allows progression to pelvic abscess, septic shock, and disseminated intravascular coagulation. Hysterectomy is reserved for refractory sepsis or gas gangrene of the uterus, not routine infection.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.