Sita presents in the hospital with complaints of bleeding per vaginum for a few days, lethargy, and fever. While taking history, she tells about consuming pills for termination of a two-month pregnancy which she bought from the market without consultation. What condition may Sita have developed?

1. A

   Incomplete abortion

2. B

   Septic abortion

3. C

   Missed abortion

4. D

   Complete abortion

Appeared in: JSSH Staff Nurse - 2019

Explanation

• Septic abortion is defined as an abortion associated with clinical evidence of uterine infection.
• The patient's history includes an unsupervised termination, a major risk factor for incomplete evacuation and subsequent infection.
• The key differentiating symptom is fever, accompanied by lethargy, which indicates a systemic infection (sepsis) originating from the uterus.
• Bacteria gain entry into the uterus and colonize the retained dead products of conception, leading to endometritis, parametritis, and potentially septicemia.

Why Other Options Were Wrong

• Option A: While the patient likely has an underlying incomplete abortion (retained products of conception), this diagnosis alone does not account for the signs of systemic infection (fever and lethargy).
• Option C: Missed abortion occurs when the fetus dies in utero but is not expelled. The patient's history is of an induced termination, not a spontaneous fetal demise that was retained.
• Option D: In a complete abortion, all products of conception are expelled. The patient's symptoms, such as bleeding and pain, would be subsiding, and there would be no fever.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differentiation of types of abortion based on clinical signs and symptoms to guide bedside assessment, documentation, and the next nursing action.
• Recognizing septic abortion is a critical nursing skill as it is a life-threatening emergency that can rapidly progress to septic shock, disseminated intravascular coagulation (DIC), and death.
• Immediate nursing priorities include hemodynamic stabilization, administration of IV antibiotics, and preparing the patient for uterine evacuation to remove the source of infection.
• This case highlights the public health importance of patient education regarding safe abortion services and contraception to prevent the severe complications of unsafe practices.

How to Approach the Question

• First, analyze the patient's history: an unsupervised termination of pregnancy using pills.
• Next, identify the key symptoms presented: vaginal bleeding, lethargy, and fever.
• Evaluate each option against the clinical picture. The presence of bleeding suggests the abortion may be incomplete.
• Focus on the most specific and severe symptom: fever. Fever in the context of a recent abortion is the hallmark of infection.
• Correlate 'infection' with the provided options. 'Septic' means related to infection or sepsis.
• Conclude that 'Septic abortion' is the most precise diagnosis as it encompasses both the abortion and the subsequent life-threatening infection.

Concept Tested & Keywords

• Concept Tested: Differentiation of types of abortion based on clinical signs and symptoms.
• Stem keywords: bleeding per vaginum, lethargy, fever, termination of pregnancy, pills without consultation
• Lead-in keywords: What condition
• Clinical cues: The combination of recent unsupervised abortion and the onset of fever is the most critical clue pointing towards a septic process.

Question ID

QD8Ez5meU9XNj98wxUo58A

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 7-12

E6 Gynecology Williams p. 153-181