<unk>  + hemodynamic instability
IVF and pRBC as needed
Misoprostol 800 mcg PR (theoretic benefit; not studied)
Uterine evacuation
If patient does not respond to above:
Uterine tamponade
Uterine artery embolization
Hysterectomy
'RPOC + sepsis
Emergent uterine evacuation
Broad spectrum antibiotics
If patient does not respond to above:
Laparotomy +/- hysterectomy to evaluate for bowel injury, pelvic abscess, clostridial myometritis<unk>  + endometritis
Cefotetan 2 g IV + doxycycline 100mg IV or PO q12h
Outpatient: Ceftriaxone 250mg IM + doxycycline 100mg BID x 14 days +/- metronidazole 500mg BID x 14 days
If patient does not respond to above:
Prompt uterine evacuation<unk>  + prolonged bleeding (hemodynamically stable)
Uterine evacuation (preferred)
Indirect evidence supports use of prophylactic antibiotics
Medical management
Misoprostol
Not studied in<unk>  but reasonable in patient who refuses surgical management
Expectant management<unk>  likely to resorb without intervention → resolution of bleeding
50-85% resolution at 1-2 week follow up
90% resolution at 6 weeks follow up
Use of prophylactic antibiotics not studied in<unk>  patients
IVF and pRBC as needed
Misoprostol 800 mcg PR (theoretic benefit; not studied)
Uterine evacuation
If patient does not respond to above:
Uterine tamponade
Uterine artery embolization
Hysterectomy
If patient does not respond to above:
Uterine tamponade
Uterine artery embolization
Hysterectomy
Uterine tamponade
Uterine artery embolization
Hysterectomy
Emergent uterine evacuation
Broad spectrum antibiotics
If patient does not respond to above:
Laparotomy +/- hysterectomy to evaluate for bowel injury, pelvic abscess, clostridial myometritis
If patient does not respond to above:
Laparotomy +/- hysterectomy to evaluate for bowel injury, pelvic abscess, clostridial myometritis
Laparotomy +/- hysterectomy to evaluate for bowel injury, pelvic abscess, clostridial myometritis
Cefotetan 2 g IV + doxycycline 100mg IV or PO q12h
Outpatient: Ceftriaxone 250mg IM + doxycycline 100mg BID x 14 days +/- metronidazole 500mg BID x 14 days
If patient does not respond to above:
Prompt uterine evacuation
Prompt uterine evacuation
Uterine evacuation (preferred)
Indirect evidence supports use of prophylactic antibiotics
Medical management
Misoprostol
Not studied in<unk>  but reasonable in patient who refuses surgical management
Expectant management<unk>  likely to resorb without intervention → resolution of bleeding
50-85% resolution at 1-2 week follow up
90% resolution at 6 weeks follow up
Use of prophylactic antibiotics not studied in<unk>  patients
Indirect evidence supports use of prophylactic antibiotics
Misoprostol
Not studied in<unk>  but reasonable in patient who refuses surgical management<unk>  likely to resorb without intervention → resolution of bleeding
50-85% resolution at 1-2 week follow up
90% resolution at 6 weeks follow up
Use of prophylactic antibiotics not studied in<unk>  patients
Retained products of conception
Hematometra
Intrauterine device complications
Ectopic pregnancy
Septic abortion
Traumatic termination
Vaginal trauma
Gestational trophoblastic disease