Which ASA grade would apply to a patient with pyometra?

• A. II or 2
• B. III or 3
• C. IV or 4
• D. V or 5

Answer: (B)

ASA classification looks at how much systemic illness is affecting the patient before surgery. Pyometra typically causes systemic illness because of infection and toxin absorption, and patients are often dehydrated and tachycardic with fever or other signs of illness. If this systemic disturbance is present but the patient is not in immediate life-threatening collapse, it fits ASA III: severe systemic disease that is not yet a constant threat to life.

ASA IV would be reserved for patients with severe systemic disease that is a constant threat to life (for example, shock or organ failure), where the risk of anesthesia is extremely high. So, pyometra commonly sits at ASA III, reflecting significant but not currently terminal systemic illness, with the understanding that emergency stabilization might be needed and a higher ASA class could be considered if the patient is critically unstable.