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Nursing QUESTION #9138
Question 1
A woman undergoes cesarean section. On day 2 postoperatively, she develops fever 38.8°C, uterine tenderness, foul-smelling lochia, and leukocytosis (WBC 18,000). The MOST likely diagnosis and empirical antibiotic regimen is:
  • Wound infection; oral amoxicillin-clavulanate only
  • Endometritis; IV Clindamycin + Gentamicin (gold standard regimen)✔️
  • UTI; oral nitrofurantoin for 7 days
  • DVT; anticoagulation therapy
Correct Answer Explanation

Post-cesarean Endometritis is the most common infectious complication after CS (incidence 10–30% without prophylaxis).

Risk factors: CS (especially emergency), prolonged ROM, prolonged labor, multiple VEs, lower socioeconomic status.

Diagnosis criteria (clinical):

  • Fever \(\geq 38.5°C\) on \(\geq 2\) occasions after 24 hours postpartum
  • Uterine tenderness (fundal)
  • Foul-smelling/abnormal lochia
  • Leukocytosis

Gold Standard Treatment: IV Clindamycin + Gentamicin

  • Clindamycin: \(900\,\text{mg}\) IV every 8 hours (anaerobic coverage)
  • Gentamicin: \(1.5\,\text{mg/kg}\) IV every 8 hours OR \(5\,\text{mg/kg}\) once daily (gram-negative coverage)
  • Continue until patient is afebrile for 24–48 hours
  • No oral follow-up needed if responded to IV therapy (ACOG recommendation)

Ampicillin is added if Enterococcus suspected (no response in 72 hours).