Differential Diagnosis
- Single most likely diagnosis
- Endometritis: This is the most likely diagnosis given the patient's symptoms of fever, heavy vaginal bleeding, and lower abdominal pain following an elective abortion. The presence of copious purulent and bloody discharge from the cervical os, a tender uterus, and an irregularly thickened endometrial stripe on ultrasound are all consistent with endometritis.
- Other Likely diagnoses
- Pelvic inflammatory disease (PID): While the adnexa are reported as normal, PID can sometimes present with similar symptoms to endometritis, including lower abdominal pain and purulent discharge. The patient's recent abortion and presence of infection increase the risk of PID.
- Retained products of conception (RPOC): The patient's history of recent abortion and ongoing heavy bleeding suggest the possibility of RPOC, which can cause infection, bleeding, and uterine tenderness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic abortion: Although the patient had an elective abortion, there is still a risk of septic abortion, especially if the procedure was not done under sterile conditions or if there were complications. Septic abortion can lead to severe infection, sepsis, and death if not promptly treated.
- Uterine perforation: This is a rare but potentially life-threatening complication of abortion. The patient's symptoms of heavy bleeding and abdominal pain could be consistent with uterine perforation, which would require immediate surgical intervention.
- Hemorrhagic shock: The patient's heavy bleeding and low blood pressure put her at risk for hemorrhagic shock, which can be fatal if not promptly treated with fluid resuscitation and blood transfusion.
- Rare diagnoses
- Uterine artery pseudoaneurysm: This is a rare complication of abortion or uterine surgery, which can cause delayed heavy bleeding. While unlikely, it should be considered if the patient's bleeding does not respond to treatment.
- Necrotizing fasciitis: This is a rare but potentially deadly infection that can occur after abortion or other surgical procedures. The patient's symptoms of fever, abdominal pain, and purulent discharge could be consistent with necrotizing fasciitis, although it is unlikely.