Question

A 32 year-old delivered a 9-pound baby and sustained a 4th-degree laceration two days ago. The delivery was complicated by a shoulder dystocia. The laceration was repaired in layers in the customary fashion. She now complains of increasing perineal pain, fever chills and weakness. Her vital signs are: blood pressure 90/50; pulse 120; and temperature 102.2°F 39°C. Her abdomen is soft, nontender and her uterine fundus is firm and nontender. Her perineum is erythematous, swollen and the laceration edges are grey. The laceration site is nontender and without feeling but there is tenderness of the surrounding tissue. What is the most likely etiology for her fevers?

A. Endomyometritis
B. Necrotizing Fascitis
C. Cellulitis
D. Hematoma
E. Proctocolitis

Answer 1

The most likely cause of the fevers in the postpartum patient is Necrotizing Fasciitis, suggested by the erythema, swelling, and characteristic appearance of the laceration site, along with systemic symptoms. The correct option is B.

Step-by-step explanation:

The most likely etiology for the fevers and symptoms described in the case of the 32-year-old patient who delivered a 9-pound baby and sustained a 4th-degree laceration with subsequent increasing perineal pain, fever, chills, and weakness is Necrotizing Fasciitis (B).

The clinical presentation of erythematous, swollen perineum with grey edges of the laceration, tenderness of the surrounding tissue, high fever, along with systemic signs of instability such as hypotension and tachycardia, are suggestive of this serious bacterial infection that rapidly destroys the fascia and fat. Necrotizing fasciitis requires prompt recognition and aggressive treatment which may include intravenous antibiotics and surgical debridement to remove the infected tissue.