Bleeding, pain, and fever four days after first-trimester termination

History of present illness: A 22-year-old gravida 1, para 0 woman presents to the emergency department with complaints of severe pelvic pain and fever to 38.3C. She reports she underwent a surgical abortion at nine weeks' gestation at an outpatient clinic four days ago. She reports the procedure was uncomplicated and she recalls being given oral antibiotics prior to the procedure. She was well until she noted pelvic discomfort and a foulsmelling discharge two days ago. She has continued to have menstrual-like bleeding since the procedure. Her past medical history is unremarkable. She complains of nausea but no emesis. She has a prescription for birth control pills that she plans to start within the next week. Physical examination General appearance: Young woman in no acute distress Vital signs: Abdomen: Soft, nondistended, tender to palpation in the suprapubic region, no peritoneal signs Pelvic: External genitalia: normal Vagina:Small amount of malodorous dark blood noted in vaginal vault Cervix: Nulliparous appearing, small amount of blood in os Uterus: Slightly enlarged, anteverted with moderate cervical motion and fundal tenderness Adnexa: Moderate tenderness, no masses palpable Laboratory studies: Imaging: Pelvic ultrasound showed an endometrial thickness of 2.7 cm consistent with retained tissue (Fig. 5.1a,