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 | ||
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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 |