A 25 year old women had an emergency lower segment caesarean section after a prolonged labour 4 days ago due to fetal distress. She now complains of intermittent vaginal bleeding and foul smelling discharge. Her O2 saturation is 98% on air, blood pressure is 124/88 mmHg, pulse of 84bpm and temperature of 37.9C. The midwife tells you that the obstetric surgeons had difficulty in removing the placenta from the uterus in the operating theatre. What is the SINGLE most likely complication of this women from the caesarean section?
A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation
Although retained products of conception may be an option. Endometritis fits more perfectly with the scenario given the fever, the history of an emergency C-section, prolonged labour and the foul discharge. Uterine infection (endometritis) Is the most common cause of postpartum fever Predisposing factors • Emergency caesarean section • Prelabour rupture of membranes • Prolonged labour • Multiple pelvic examinations. • Internal fetal monitoring - use of scalp electrodes/ intrauterine Signs and symptoms • Fever usually in proportion to the extent of infection. • Foul smelling, profuse, and bloody discharge. • Tender bulky uterus on abdominal examination
Management • Antibiotics