A 19-year-old woman, G1P0, presented for a follow-up evaluation 9 days after receiving intramuscular methotrexate for medical abortion. She reported that she bled heavily the day that she inserted the misoprostol vaginally (4 days after the methotrexate injection) but was not sure if she had passed the pregnancy. Over the subsequent week she developed gradually worsening fever and lower abdominal pain. She also reported a vaginal discharge. Her temperature at the time of her clinic visit was 101.8 degrees Fahrenheit, and pelvic examination revealed an enlarged, boggy, tender uterus.
Resolution of Case 7
The patient's ultrasound study showed a widened endometrial stripe indicative of uterine debris, which is often found in the days following medical abortion. (Click here to view Figure 4.) However, her clinician concluded that the history of sustained fever and abdominal pain coupled with her findings on physical exam were most consistent with a diagnosis of uterine infection. The patient was hospitalized and treated with surgical aspiration and intravenous cefoxitin and doxycycline. Her symptoms resolved in 3 days, and she was discharged on oral doxycycline to complete a 14-day course.
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