Puerperal Sepsis

A 28-year-old primigravida delivered vaginally 4 days ago with an episiotomy. She now presents with fever (38.8°C), foul-smelling lochia, lower abdominal tenderness, and mild costovertebral angle tenderness. Pulse is 110/min, BP 100/65 mmHg. CBC shows WBC 16,500/µL with left shift. Urine culture is pending; blood culture has been sent. What is the most appropriate immediate management?

A 32-year-old woman is on postoperative day 3 after emergency lower segment cesarean section for fetal distress. She had prolonged rupture of membranes (18 hours) and intraoperative blood loss of 800 mL. She now presents with fever (39.2°C), severe lower abdominal pain, and vaginal bleeding. On examination: BP 95/58 mmHg, HR 128/min, uterus is tender and boggy, lochia is profuse and foul-smelling. WBC 18,200/µL, Hb 7.8 g/dL, platelets 95,000/µL. PT/INR prolonged. What is the most likely diagnosis?

Which of the following organisms is the MOST common cause of puerperal sepsis in India?

A 28-year-old primigravida delivers vaginally after 18 hours of labour with spontaneous rupture of membranes 16 hours prior to delivery. On postpartum day 3, she presents with fever (38.8°C), foul-smelling lochia, lower abdominal tenderness, and uterine tenderness on examination. Her WBC is 14,500/μL with left shift. Blood cultures are pending. What is the most appropriate next step in management?

A 32-year-old woman, 5 days post-caesarean section, presents with high fever (39.5°C), severe lower abdominal pain, and tachycardia (HR 110/min). On examination, she has marked uterine tenderness and a palpable tender mass in the right lower abdomen. Abdominal ultrasound shows a 4 cm hypoechoic collection adjacent to the uterus. Her WBC is 16,200/μL. She has been on ceftriaxone and gentamicin for 48 hours with no clinical improvement. What is the most likely diagnosis and the next step in management?