Mrs A. presented to the local health clinic with a two-day history of severe lower abdominal pain, high fever, and heavy vaginal bleeding. She reported feeling weak and dizzy, with intermittent chills. On questioning, she initially denied any recent history of pregnancy but later admitted to a recent missed period followed by a spontaneous miscarriage.

Mrs A has had two prior pregnancies, both resulting in uncomplicated vaginal deliveries. She has no history of chronic illnesses or surgeries. There is no known history of sexually transmitted infections (STIs).

Mrs A lives in a rural community with limited access to healthcare. Her husband is a subsistence farmer, and the family struggles with financial insecurity. Due to cultural and religious beliefs, discussions about contraception and family planning are rare. Abortion is legally restricted in her region, and the stigma surrounding it is high.

Mrs A revealed that after missing her period, she sought advice from a traditional healer due to the family's financial constraints and fear of social repercussions if another child were born too soon. The healer provided her with a concoction of herbs and roots, assuring her it would "cleanse her womb." After taking the mixture, Mrs A experienced intense cramping and began to bleed heavily. The bleeding persisted for two days, during which she became increasingly weak and febrile.

- General: Mrs A appeared pale, weak, and in obvious distress. She was febrile (38.9°C), with a rapid, weak pulse (120 beats per minute) and low blood pressure (90/60 mmHg).

- Abdomen: Tenderness in the lower abdomen, with guarding and rebound tenderness suggestive of peritonitis.

- Pelvic Examination: Severe vaginal bleeding, with clots. The cervix was open, and there were signs of retained products of conception.

- Haemoglobin: 7.5 g/dL (indicating significant blood loss)

- White Blood Cell Count: 15,000 cells/µL (suggesting infection)

- Ultrasound: Confirmed retained products of conception with evidence of uterine perforation.

- Urine Culture: Positive for Escherichia coli (E. coli).

- Septic Abortion with Uterine Perforation

- Severe Anaemia

- Sepsis

Mrs A was urgently referred to the regional hospital for surgical intervention. Upon arrival, she was stabilized with intravenous fluids, broad-spectrum antibiotics, and a blood transfusion. An emergency dilation and curettage (D&C) were performed to remove the retained products of conception and repair the uterine perforation.

Mrs A's condition slowly improved with intensive care, though her recovery was complicated by prolonged hospitalization due to sepsis. Her experience highlighted the dangers of unsafe abortion practices and the urgent need for improved access to safe reproductive healthcare in her community.