QUESTION 12

 A 39-year-old woman, gravida 4 para 3, comes to the emergency department after 2 days of fever, heavy vaginal bleeding, and lower

abdominal pain Six days ago, she had an elective abortion at an outside clinic at 8 weeks gestation. Since the procedure, the patient

has had bleeding that has become increasingly heavy and malodorous and is now soaking through a pad every 2-3 hours. She has

no medical problems, takes no medications, and has no allergies. Temperature is 39.8 C (103 7 F}, blood pressure is 100/65 mm Hg,

pulse is 108/min, and respirations are 16/min. Physical examination reveals lower abdominal tenderness but no rigidity or guarding

Pelvic examination shows copious foul-smelling, purulent, and bloody discharge from the cervical os. Bimanual examination shows a

tender, anteverted, soft uterus that is 12 weeks in size. Transvaginal ultrasound reveals a 12-cm uterus with an irregularly thickened

echogenic endometrial stripe with active blood flow. The adnexa are normal bilaterally, and there is a small amount of free fluid in the

pelvis. She is started on broad-spectrum intravenous antibiotics. Which of the following is the most appropriate next step in

management of this patient?

QA Hysterectomy

0 B. Methotrexate

0 C. Misoprostol

0 D. Observation

0 E. Suction curettage