Postpartum Fever Workup

History: Postpartum fever is $100.4 F (38 degrees C) on 2 occasions >6h apart after the first postpartum day (during the first 10 days postpartum), or $ 101 on the first postpartum day. Dysuria, abdominal pain, distention, breast pain, calf pain.

Predisposing Factors: Cesarean section, prolonged labor, premature rupture of membranes, internal monitors, multiple vaginal exams, meconium, manual placenta extraction, anemia, poor nutrition.

Physical Examination: Temperature, throat, chest, lung exams; breasts, abdomen. Costovertebral angle tenderness, uterine tenderness, phlebitis, calf tenderness; wound exam. Speculum exam.

Differential Diagnosis: UTI, upper respiratory infection, atelectasis, pneumonia, wound infection, mastitis, episiotomy abscess; uterine infection, deep vein thrombosis, pyelonephritis, pelvic abscess.

Labs: CBC, SMA7, blood C&S x 2, catheter UA, C&S. Endometrial Pipelle sample or swab for gram stain, C&S; gonococcus, chlamydia; wound C&S, CXR.

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