A 27-year-old woman develops fever, lower abdominal pain, and foul-smelling vaginal discharge five days after an unsafe abortion performed outside a health facility. Pulse is 120 per minute, blood pressure 88/60 mmHg, and the uterus is tender at 10-week size. What is the best immediate management?
- A Vaginal misoprostol 800 microgram with oral antibiotics
- B Immediate suction evacuation before starting any antibiotics
- C Intravenous broad-spectrum antibiotics followed by evacuation of the uterus ✓
- D Total hysterectomy as the definitive source control
Correct answer: C. Intravenous broad-spectrum antibiotics followed by evacuation of the uterus
Explanation
Septic abortion is managed with resuscitation, parenteral broad-spectrum antibiotics covering anaerobes and coliforms, followed by prompt evacuation of retained products once the patient is stabilised. Evacuating before antibiotic cover risks bacteraemic dissemination. Medical management alone leaves infected tissue in situ. Hysterectomy is reserved for refractory cases such as clostridial myometritis unresponsive to antibiotics and drainage.
Reference: Dutta's Textbook of Obstetrics, 10th ed.
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