Fever after deliver a baby - yoda1

[ArchivalUser]

On the morning of the second day after delivering a 3,500-g infant, a 16-year old gravida 1, para 0 develops a temperature of 1010 F (38.30C). Her antepartum course was unremarkable. Membranes ruptured shortly after hospital admission and the onset of labor was spontaneous but desultory. Oxytocin augmentation was necessary. The first stage of labor was 22 hours; the second stage was 3 hours and 45 minutes. Delivery of the vertex was expedited by vacuum forceps over an intact perineum under pudendal block anesthesia. The placenta delivered spontaneously. Since delivering, she had been ambulating and eating well. Physical examination reveals a temperature of 1020F (38.80C), a pulse of 108 bpm, respirations 22/min, and a blood pressure of 110/60. Breasts are full with moderate colostrum secretion from the nipples. The abdomen is soft; there is no liver, kidney, or spleen palpable. The perineum is clean, and the lochia rubra has a foul odor. Pelvic examination is within normal limits for postpartum status except for uterine tenderness to motion and foul lochia. Examination of the extremities, including previous intravenous sites, is within normal limits. Which of the following is the next best step in her management?

(A) Begin oral methylergonovine, encourage fluid intake, re-evaluate in four hours
(B) Culture the lochia and start acetaminophen; await culture report
© Initiate imipenem/cilastatin intravenous therapy
(D) Order a CBC, encourage fluid intake, re-evaluate in four hours
(E) Start a first-generation cephalosporin orally

[ArchivalUser]

cc

[ArchivalUser]

CC?

[ArchivalUser]

eeeeee

[ArchivalUser]

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[ArchivalUser]

The correct answer is C. The patient has endometritis based on the following facts: fever, uterine tenderness, and foul lochia. The following factors predisposed this patient to infection: prolonged labor, prolonged rupture of the membranes, operative delivery, and multiple examinations. Other factors that predispose to the postpartum development of endometritis include: chorioamnionitis, toxemia, intrauterine pressure catheters (>8 hours), fetal scalp electrode monitoring, preexisting vaginitis or cervicitis, cesarean section, intrapartum and postpartum anemia, poor nutrition, obesity, low economic status, and coitus near term. The most common cause of postpartum fever is uterine infection. Extragenital infections are much less common than endometritis and urinary tract infections. Bedside history regarding coughing, chest pain, breast tenderness, leg pain, and pain at the site of the previous intravenous infusions, and a physical examination should be performed, covering these same areas of possible infection. Fever after the exclusion of other causes remains the most important criteria for the diagnosis of endometritis. The microbiology of endometritis is polymicrobial. Commonly isolated aerobes include gram-negative bacilli (e.g., E. coli) and gram-positive cocci (e.g., group B streptococci). Therefore, a broad-spectrum antibiotic should be chosen, such as imipenem/cilastin. Good results have been reported with other antibiotics, such as cefoxitin and Clindamycin/aztreonam

[ArchivalUser]

nice q yoda
but the standard of treatment is not as the answer suggested,

the combination of choice is either:

IV clindamycin + gentamicin OR

2nd/3rd generation cephalosporin + metronidazole

[ArchivalUser]

thanx