tailieunhanh - Thực hành xử lý sản khoa - Trường hợp 3

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 3', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 46 A 23-ycar-oid woman underwent a dilation and curettage D C for an incomplete abortion 3 days previously. She complains of continued vaginal bleeding and lower abdominal cramping. Over the last 24 hr she notes significant fever and chills. On examination her temperature is F BP 90 40 and HR 120 bpm. The cardiac examination reveals tachycardia and the lungs arc clear. There is moderately severe lower abdominal tenderness. The pelvic examination shows the cervix to be open to cm and there is uterine tenderness. The leukocyte count is 20 000 mm3 and the hemoglobin level is 12 g dL. The urinalysis shows 2 wbc hpf. What is the most likely diagnosis What is the next step in management 3 60 CASE Illis OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 46 Abortion Septic Summary A 23-year-old woman who had undergone a D c 3 days ago for an incomplete abortion complains of continued vaginal bleeding lower abdominal cramping and fever and chills. Her temperature is U BP 90 40 and HR 120 bpm. The lungs are clear. There is moderately severe lower abdominal tenderness. The cervix is open and there is uterine tenderness. The laboratory studies are significant for leukocytosis and a normal urinalysis. Most likely diagnosis Septic abortion with retained products of conception . Next step in management Broad-spectrum antibiotics followed by dilatation and curettage of the uterus. Analysis Objectives 1. Understand the clinical presentation of septic abortion. 2. Know that the treatment of septic abortion involves both antibiotic therapy and uterine curettage. Considerations This 23-year-old woman underwent a D c procedure for an incomplete abortion 3 days previously and now presents with lower abdominal cramping vaginal bleeding fever and chills. The open cervical os lower abdominal cramping and vaginal bleeding suggest retained products of conception POC . The retained POC may lead to ongoing bleeding or infection. In this case the fever chills and leukocytosis point