Sita presents in the hospital with complaints of bleeding per vaginum since 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?

Appeared in: NHM MP Staff Nurse-2019

Explanation

Septic abortion is defined as any abortion associated with clinical evidence of uterine infection.
The patient's symptoms of fever, lethargy, and vaginal bleeding are hallmark signs of this condition.
The history of an unsupervised termination of pregnancy significantly increases the risk of infection due to non-sterile techniques or retained products of conception, which serve as a medium for bacterial growth.
Fever is the key symptom that distinguishes septic abortion from other types like incomplete or complete abortion, where infection is not a primary feature.

Option A: While incomplete abortion involves vaginal bleeding and may have retained products, fever is not a defining characteristic unless a secondary infection has developed. The primary symptoms are persistent bleeding and abdominal cramps.
Option C: In a missed abortion, the fetus has died but remains in the uterus. There is typically no expulsion of tissue, and symptoms like significant bleeding and fever are usually absent. The cervix remains closed.
Option D: In a complete abortion, all products of conception have been expelled from the uterus. The bleeding and abdominal pain would have subsided, and the cervix would be closed. There would be no fever.

Clinical Relevance

Nursing practice connection: Use the key finding related to The question tests the ability to differentiate between various types of abortion based on clinical signs and symptoms, particularly in the context of an unsafe termination of pregnancy to guide bedside assessment, documentation, and the next nursing action.
Recognizing septic abortion is a critical nursing skill as it is a life-threatening obstetric emergency that can rapidly progress to septic shock and death if not treated promptly.
Nurses play a vital role in the initial management, which includes stabilizing the patient with IV fluids, administering broad-spectrum antibiotics, monitoring vital signs, and preparing for uterine evacuation.
Patient education on safe abortion practices and post-abortal contraception is a key nursing responsibility to prevent future occurrences of unsafe abortions and their complications.

How to Approach the Question

First, analyze the patient's clinical presentation by identifying the key symptoms: vaginal bleeding, lethargy, and fever.
Next, consider the patient's history: a recent, unsupervised termination of pregnancy. This is a significant risk factor for complications.
Evaluate each option based on the classic definitions of different types of abortion.
The presence of fever is the most important clue. It points directly to an infectious process.
Correlate the triad of symptoms (bleeding, fever, lethargy) and the history (unsafe abortion) to determine the most fitting diagnosis.
Septic abortion is the only option that accounts for all the clinical findings, especially the fever, which indicates infection.

Concept Tested & Keywords

Concept Tested: The question tests the ability to differentiate between various types of abortion based on clinical signs and symptoms, particularly in the context of an unsafe termination of pregnancy.
Stem keywords: bleeding per vaginum, lethargy, fever, termination of a two-month pregnancy, without consultation
Lead-in keywords: What condition
Clinical cues: The combination of fever, bleeding, and a history of unsupervised abortion is a classic presentation of septic abortion.

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

E6 Gynecology Williams p. 153-181

Practise the full NHM MP Staff Nurse-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.