8 days after cesarean section a new mother presented with fever of 101.4degF. On examination her uterus is soft and extremely tender. Puerperal infection is confirmed. She mostly have:
Most women with fever in the postpaum period have endometritis. Urinary tract infection is the next most common infection. caesarean section is easily the most common identifiable risk factor for development of puerperal infection. Fever and a soft, tender uterus are the most prominent signs of endometritis. Risk factors are, Prolonged rupture of the membranes (>24 hours) Chorioamnionitis An excessive number of digital vaginal examinations Prolonged labor (>12 hours) Toxemia Intrauterine pressure catheters (>8 hours) Fetal scalp electrode monitoring Preexisting vaginitis or cervicitis Operative vaginal deliveries Caesarean section Intrapaum and postpaum anemia Poor nutrition Obesity Low socioeconomic status Coitus near term Ref: Poggi S.B. (2013). Chapter 21. Postpaum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
Vaginitis
Endometritis
Parametritis
Salpingitis