Approach to postpartum fever Quiz: Ace Your Exams

A 28-year-old primigravid woman undergoes an uncomplicated c-section and is discharged home on postpartum day 2. The patient then presents to the emergency department the following day with fever and abdominal pain and is readmitted to the hospital and started on appropriate antibiotics for presumed endometritis. Three days later, on postpartum day 6, the nurse reports persistent fevers, tachycardia, and worsening pelvic pain. There is no dysuria or cough, and lochia is minimal. Past medical history is unremarkable. Current medications include ampicillin, gentamicin, clindamycin, and analgesics as needed. Temperature is 38.9°C (102°F), heart rate is 128/min, respirations are 18/min, blood pressure is 78/50 mmHg, and oxygen saturation is 98% on room air. Abdominal examination reveals mild tenderness in the lower quadrants without rebound or guarding. A low transverse abdominal incision is clean, dry, and intact. The lungs are clear to auscultation, and there is bilateral pitting edema in the lower extremities, which is worse on the left side. A complete blood count (CBC) shows a white blood cell (WBC) count of 15,000/mm³ with a left shift. Urinalysis and urine culture are negative. What is the best next step in management?