2.         Mrs Pang had a forceps delivery 4 days ago. She is now having a swinging fever with crampy abdominal pain. The lochia is heavy and offensive. On examination the uterus is 20 weeks size, tender with a patulous cervical os.

a)         What is the diagnosis?

            Puerperal sepsis.

b)         What is the most likely cause?

            Retained products of conception.

c)         What is the immediate management plan?

            Start on broad-spectrum antibiotics.

d)         What operative procedures may be necessary?

            Evacuation of uterus.

e)            Immediately after the above operation, you encounter excessive bleeding. Name 2 medical measures you would take.

            Syntocinon and ergometrine.

f)          The above measures you take is unable to control the bleeding. Name 1 surgical procedure you would do.

            Laparotomy.