Approach to postpartum fever Quiz: Ace Your Exams

A 32-year-old woman presents to the OB/GYN clinic 3 days postpartum after an uncomplicated c-section with fever and increasing lower abdominal pain. The pain has worsened over the past 2 days, and there is increasing drainage from the incision. There is no cough, chest pain, shortness of breath, or dysuria, and lochia is decreasing. The pregnancy was complicated by breech presentation that did not resolve with an external cephalic version (ECV) attempt. Temperature is 38.5°C (101.3°F), heart rate is 94/min, respirations are 18/min, and blood pressure is 130/75 mmHg. Physical examination reveals erythema, warmth, and purulent discharge at the incision site. The uterine fundus is palpable 3 cm below the umbilicus and is mildly tender. There is bilateral pitting edema in the feet, and the remainder of the examination is unremarkable. Which of the following is a risk factor for the patient’s most likely diagnosis?