Monday, April 4, 2011

Unseen

A G1P0 woman has an illegal abortion done on the streets. Several days later, she presents to the emergency department with high fever, chills, malaise, and abdominal pain. Vaginal discharge is both bloody and purulent. On physical exam, her heart rate is 120, respiratory rate 25, and she has low abdominal tenderness. A boggy, tender uterus with a dilated cervix is palpated.

Challenge: After stabilization, what is the medical and surgical management of this condition? What antibiotics would you choose?

1 comment:

Craig Chen said...

Unseen

There are several antibiotic regimens for septic abortions including: (1) clindamycin, gentamicin, +/- ampicillin, or (2) ampicillin, gentamicin, and metronidazole, or (3) levofloxacin and metronidazole, or (4) ticarcillin-clavulanate, or (5) piperacillin-tazobactam, or (6) imipenem. Surgical evacuation of uterine contents is also important.

Source: UpToDate.