She had a perineal pad soaked with blood, cervix was posterior, firm in consistency, os was patulous, gloved fingers were stained with altered blood. A size 16 Foley’s catheter was in situ draining concentrated urine. Resuscitation was achieved using intravenous fluids, dopamine infusion, and three units of blood, she was commenced on anticoagulation: subcutaneous enoxaparin, intravenous antibiotics and haematinics. However, medications were not regular because of lack of funds. Full blood count result are PCV of 22%, leucocytosis of 33.62 x 109 cells/μl
with predominant neutrophilia, platelet count of 37 x 109 cells/μl;
prothrombin time was prolonged (-26.1sec, INR-3.34); random
blood sugar was 42mg%, this was subsequently corrected;
pregnancy test was positive; abdomino-pelvic ultrasound scan
showed that uterus was bulky, with a gestational sac (CRL-
2.8cm=9W4D), a foetal pole, however, there was no cardiac
activity. Cervical os was closed; features were in keeping with
a missed abortion. Following adequate resuscitation, a manual
vacuum aspiration of the products of conception was performed.
About 100ml of product of conception was evacuated from the
uterus.
Management was hampered by lack of funds as patient could
not carry out all the investigations requested for her care (e.g.
Blood culture, Doppler study of the limbs, D dimer assay, protein
C and S assay, Diagnostic Arteriography) and pay for amputation
of the affected parts.