| Etiology | • polymicrobial infection of retained products of conception |
|---|---|
| Risk factors | Retained POC from: |
| • Elective abortion with nonsterile technique | |
| • Missed or incomplete abortion (rare) | |
| Clinical presentation | • Fever, chills, abdominal pain |
| • Sanguinopurulent malodorous vaginal discharge | |
| • Boggy, tender uterus; dilated cervix | |
| • Pelvic ultrasound: retained POC (intrauterine echogenic material with blood flow), thick endometrial stripe | |
| Management | |
| emergency **** | • Intravenous fluids |
| • Broad-spectrum antibiotics | |
| • Suction curettage (prompt uterine evacuation of infected POC) |
A hysterectomy is indicated if the patient has a pelvic abscess or if the patient's condition does not improve after suction curettage and 48 hours of broad-spectrum antibiotics.
(Choice D) Mifepristone, an antiprogesterone, and misoprostol, a synthetic prostaglandin, are a regimen commonly used for both medical management of spontaneous abortions and elective terminations of pregnancy. Because of their slow onset of action, they are not used for the treatment of septic abortion, which requires prompt uterine evacuation.
It can occur as a complication of any type of abortion but most frequently follows an unsterile and/or incomplete procedure for an elective abortion.
When dilation and curettage (eg, performed for a missed abortion) do not completely evacuate the uterus, ascending vaginal flora can seed the uterus and retained products of conception through the dilated cervix, resulting in infection.
Although the infection usually remains confined to the retained products of conception if untreated or observed, it can spread into the uterine myometrium and cause widespread infection.