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.
- Ectopic pregnancy: Although the patient had an abortion, there is still a small chance of an ectopic pregnancy, especially if the abortion was incomplete or if there were multiple gestations. Ectopic pregnancy can cause severe abdominal pain, bleeding, and death if not promptly diagnosed and treated.
- Rare diagnoses
- Uterine artery pseudoaneurysm: This is a rare complication of abortion or uterine surgery, which can cause heavy vaginal bleeding and abdominal pain.
- Asherman syndrome: This is a rare condition characterized by the formation of adhesions in the uterus, which can cause abnormal uterine bleeding, infertility, and other complications. While it is unlikely in this case, it could be considered if the patient's symptoms persist or recur after treatment for endometritis.