Review Question - QID 106944

This patient is presenting with a fever and uterine tenderness after a prolonged delivery which is suggestive of postpartum endometritis.

Postpartum endometritis is an infection of the decidua that most commonly occurs between 24 and 72 hours postpartum. The risk of this condition increases significantly in patients who undergo a cesarean section. In these patients, intraoperative antibiotics significantly decrease the risk of postpartum endometritis. Other risk factors for this condition include young maternal age, obesity, chronic conditions, and prolonged labor. The typical presentation is a fever and uterine tenderness as well as foul-smelling lochia. The treatment is broad-spectrum antibiotics such as clindamycin and gentamicin or doxycycline and ampicillin-sulbactam.

Incorrect Answers:
Answer 1: Atelectasis can present with a fever and pulmonary crackles within 24 hours of surgery. This patient may have atelectasis; however, her current high fever and uterine tenderness suggest a diagnosis of endometritis as the etiology of her symptoms.

Answer 2: Chorioamnionitis is a bacterial infection of the amnion and chorion membranes and is associated with premature rupture of membranes. This condition presents with maternal fever, maternal and fetal tachycardia, foul vaginal discharge, and uterine tenderness which occurs during labor (not several days later).

Answer 3: Deep vein thrombosis presents with a red, hot, swollen, and tender leg. The diagnosis can be confirmed with an ultrasound and treatment involves an anticoagulant such as heparin.

Answer 5: Urinary tract infection (UTI) presents with a fever and dysuria usually on postoperative day 3. This patient may have dysuria or merely increased urinary frequency from an alternative cause. Her high fever and uterine tenderness are not suggestive of a UTI.

Bullet Summary:
Endometritis presents with a fever, uterine tenderness, and foul-smelling lochia.