Mrs. X, age 60, was admitted to the hospital with abdominal pain, distension, and fever. She was diagnosed with pyometra based on her symptoms and ultrasound findings of an infected uterus. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Her treatment included antibiotics, analgesics, and antacids. She was counselled on her diet and medications upon discharge and prescribed a course of antibiotics to complete at home.

1. CASE STUDY ON
PYOMETRA
PRESENTED BY,
MOHAMMAD IRFAN ABDUL KADER

2. DEMOGRAPHIC DETAILS
Name: Mrs.X Age: 60 Sex: Female
IP No. 274001/21 DOA: 22/3/21 DOD: 27/3/21
SUBJECTIVE EVIDENCE
REASON FOR ADMISSSION
 c/o abdominal pain
 c/o abdominal distension since 1 month
 c/o fever
 Gas trouble since 1 month

3.  PAST MEDICAL HISTORY
 K/C/O DM x 10 yrs
 K/C/O BA x 20 yrs
 PAST MEDICATION HISTORY
 T.Glycomet Trio 1-0-1
 Rotahaler (Fluticasone 250 mcg+ Salmetrol 25 mcg)
 SH/FH/ALLERGIES
 Mixed diet
 Appetite decreased
 MENSTRUAL HISTORY: Menopause at 45 yrs

4.  OBJECTIVE EVIDENCE
 VITAL SIGNS
VITALS 1 2 3 4 5 6
BP (mmHg) 120/70 120/70 130/80 150/90 120/80 120/80
PR (bpm) 72 76 94 84 74 74
SYSTEMIC EXAMINATION
 O/E : Pallor (+)
 P/A : Vulva vagina (+)

5.  LABORATORY EXAMINATION
PARAMETERS OBSERVED VALUE REFERENCE
VALUE
TC (cells/cumm) 9100 4000-11000
DC P68% L29% E03% P40-60% L20-40%E0-6%
ESR (mm/hr) 20 0-20
Plt (cells/cumm) 4.1 lakhs 1.5-4.5 lakhs
RBS (mg/dl) 193 70-140
FBS (mg/dl) 120 70-115
PPBS (mg/dl) 170 120-140
Hb (gm%) 11.8 11.2 9.1 12.5-15.5
USG Abdomen:
• Atrophy with inflamed uterus, ovary.

6.  ASSESSMENT
 Based on the subjective and objective evidence the patient
was diagnosed to have
 PYOMETRA

7.  DEFINITION
• Pyometra is defined as an
infection in the uterus.
• The uterus is also known as the
womb and is where the
developing foetus is located.
• It is a serious and life threatening
condition that must be treated
promptly and aggressively.
• Pyometra is often the result of
hormonal changes in the
reproductive tract.

9.  PATHOPHYSIOLOGY
Progesterone stimulates endometrial
growth and glandular secretion that
provides excellent media for bacteria
Progesterone reduces
myometrium contractility and
maintain cervical closure
Glands fail to empty due to
scarring around the opening of
gland or due to reduce myometrial
contraction

10. Results in cystic
endometrial hyperplasia
(CEH)
During bacteria entering
uterus through vagina or
bloodstream conducive to
bacterial overgrowth
PYOMETRA

11. SYMPTOMS DIAGNOSIS
 Ultrasound
 CT Scan
 MRI Scan
 Doppler scanning is
helpful in detecting blood
flow changes
when pyometra complicat
es endometrial cancer.
• Lower abdominal pain
• Purulent vaginal discharge
• Enlarged uterus
• Vomiting
• Loss of appetite
• Depression
• Increased drinking and urinating
• Fever

12.  TREATMENT

15.  PLAN
No
.
MEDICATION GENERIC NAME DOSE AND
FREQUEN
CY
1 2 3 4 5 6
1. BETADINE
VAGINAL PACK
POVIDONE -
IODINE
200 mg BD √ √
2. INJ. TAXIM CEFOTAXIME 1 g IV
1-0-1
√ √ √ √ √ √
3. INJ.RANTAC RANITIDINE 50 mg IV √ √
4. INJ.EMESET ONDANSETRON 4 mg IV √ √
5. T. GLYCOMET
TRIO 2
METFORMIN 500
mg+ GLIMEPRIDE
1 mg+VOGLIBOSE
0.2 mg
1-0-1 √ √ √ √ √
6. INJ.TRAPIC TRANEXAMIC
ACID
100mg/ml
BD
√ √
7. INJ.METROGYL METRONIDAZOLE 500 mg
BD
√ √ √ √

16. 8. INJ.FORTWIN PENTAZOCINE 30mg IM √
9. INJ. TRAMADOL TRAMADOL 50 mg IV
sos
√ √ √ √
10. DICLOFENAC
SUPPOSITORY
DICLOFENAC 100 mg BD √ √
11. INJ. P MOL ACETAMINOPHEN 1 g IV
1-0-1
√ √
12. T. LYSER D DICLOFENAC 50
mg +
SERRATIOPEPTID
ASE 10 mg
1-0-1 √ √

17.  MONITORING PARAMETERS
 MONITORING THERAPEUTIC OUTCOME
DATE RELEVANT INFORMATION
22/3/21 Pallor (+)
Surgery- TAH + Bilateral Salpingo-oophorectomy
23/3/21 Pallor (+)
P/A : soft, tender
24/3/21 P/V Bleeding
c/o constipation
MEDICATIONS MONITORING PARAMETERS
TAXIM CBC, RFT
RANTAC Vitamin B12, Serum magnesium
FORTWIN Hypotension, sedation and respiratory
depression
LYSER D RFT, CBC, Blood pressure

18.  DISCHARGE MEDICATIONS
NO. BRAND NAME GENERIC NAME DOSE DURATION
1. T.TAXIM O CEFIXIME 200 mg BD
2. T.RANTAC RANITIDINE 150 mg
1-0-0 1 week
3. T. LYSER D DICLOFENAC 50
mg+
SERRATIOPEPTIDA
SE 10 mg
1-0-1

19.  CLINICAL PHARMACIST ACTIVITIES
DATE DRUG RELATED
PROBLEMS
COMMENTS
22/3/21 NO DRUG FOR
INDICATION
• Hb level is decreased
• c/o constipation, no drug is
prescribed
25/3/21 ENCOUNTERED
ADR
Tramadol induced constipation.
26/3/21 DRUG
INTERACTION
Pentazocine<> Tramadol
Reduced analgesic effect and
increased risk of serotonin
syndrome

20.  PATIENT COUNSELLING
 DISEASE BASED COUNSELLING
• Pyometra is collection of pus in the uterine cavity with several
aetiologies like malignancy of genital tract more commonly and
sometimes benign lesions and other benign conditions.
• Clinical presentation of pyometra is a whitish discharge per
vaginum and sometimes lower abdominal pain and bleeding per
vaginum also.

21.  DIET BASED COUNSELLING
 FOODS TO AVOID
• A diet high in trans fat.
• Red meat consumption.
• Gluten.
 FOODS TO INCLUDE
• Fibrous foods, such as fruits, vegetables, legumes, and whole grains
• Iron-rich foods, such as dark leafy greens, broccoli, beans, fortified grains, nuts,
and seeds
• Foods rich in essential fatty acids, such as salmon, sardines, herring, trout,
walnuts, chia, and flax seeds
• Antioxidant-rich foods found in colorful fruits and vegetables, such as oranges,
berries, dark chocolate, spinach, and beets

23.  DRUG BASED COUNSELLING
 T. TAXIM O
• The antibiotic course should be completed
 T.RANTAC
• Take the tablet 30 minutes before food or 2 hours after food.
 T. LYSER D
• Take it with food to avoid getting an upset stomach
• Take the tablet at a fixed time.

24. THANK
YOU