Case 13 · Obstetrics
Septic abortion
A frightened 24-year-old is in septic shock with a foul discharge, days after pills from a chemist and instrumentation by an untrained provider. Take the history privately and without judgement, resuscitate, give antibiotics that cover anaerobes, evacuate the uterus at the right time, and prevent tetanus.
About this case
What you will practise
Learning objectives
- Suspect pregnancy-related sepsis in any young woman with fever and shock, and test for pregnancy.
- Take a private, non-judgemental history of an unsafe abortion.
- Complete the sepsis bundle: lactate, cultures, antibiotics, fluid and vasopressors.
- Choose antibiotics that cover Gram-negative, Gram-positive and anaerobic organisms.
- Control the source by uterine evacuation under antibiotic cover, and know when laparotomy is needed.
- Give tetanus prophylaxis and plan follow-up, contraception and confidentiality.
Key decisions this case tests
- What question unlocks the diagnosis?
- Is ceftriaxone alone enough?
- Evacuate now, after antibiotics, or wait for 48 hours of antibiotics?
- Vacuum aspiration, misoprostol or hysterectomy?
- Tetanus vaccine alone, or immunoglobulin too?
Reference basis
- World Health Organization. Abortion care guideline (2022); Managing complications in pregnancy and childbirth, 2nd edition (2017).
- Surviving Sepsis Campaign international guidelines (2021).
- Ministry of Health and Family Welfare, Government of India. Comprehensive abortion care guidelines (2018).
- Local antibiogram for empirical antibiotic choice.
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
The physiology is a simplified teaching model: bacterial burden, antibiotic effect, fluid and vasopressor responses are timed for learning, not prediction. Doses follow the cited guidelines but have not yet been signed off by a clinician.
Visle is for education only and is not medical advice. Fever, pain or heavy bleeding after an abortion needs urgent medical care. Safe abortion services are legal in India under the MTP Act.
Ready for another emergency?
Case 12 puts you beside a 33-week mother with a pounding headache and BP 168/112.