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Table 1 Subacute uterine inversion case management timeline

From: Subacute uterine inversion following an induced abortion in a teenage girl: a case report

Preceding events

The nulliparous unmarried adolescent had not planned to become pregnant, and lacked access to safe contraceptive. She attempted to secretly induce abortion from rural clinic without success. She had surgical uterine evacuation at a distant clinic and suffered serious complications

Dates

Visit(s) summary

Investigations done

Treatment given

26.01.2020

Adolescent sought abortion service at rural clinic but did not succeed.

Not documented

•Oral misoprostol

30.01.2020

Sought further assistance at another peripheral clinic

Not documented

•Surgical uterine evacuation was conducted patient discharged

02.02.2020

Initial visit:

Clinical diagnosis of Subacute uterine inversion complicated with hemorrhagic shock and sepsis was made

Full hemogram showed hemoglobin level of 4.5 g/dl, and 12,600 leucocytes per microliter predominantly neutrophils (89%)

•Immediate resuscitation with crystalloid and blood transfusion (3 units).

•Initiated injectable diclofenac 75 mg, metronidazole 500 mg and ceftriaxone 2 g

03.02.2020 to 08.02.2020

Inpatient care:

Patient generally had uneventful post-operative period.

N/A

•Urgent life-saving surgical correction of the inversion, and total abdominal hysterectomy due to necrotic uterine fundus

•Continued fluid and blood resuscitation (1 unit) as well as injectable antibiotics and analgesia

•Had a psychotherapist review

09.02.2020

Discharge day

Post transfusion hemoglobin level was 8.1 g/dl

•Discharged on oral ferrous 200 mg and cefixime 500 mg daily for five days

•Given appointment of 21.02.2020

25.02.2020

Follow up visit

•Came three days past the appointment date

•She had well recovered, and wound healed

•Hemoglobin level was 9.7 g/dl

•Had concern about future fertility options

Linked to hospital’s social worker for psychosocial support and community liaison