642.

Explanation

Core Concept: Puerperal sepsis (postpartum infection) is an infection of the reproductive tract occurring after childbirth. The Joint Commission on Maternal Health defines it using specific temperature criteria to distinguish it from normal postpartum physiological changes (like breast engorgement).

Clinical Presentation:

• Fever, chills, malaise, anorexia.
• Pelvic pain, uterine tenderness, foul-smelling lochia.

Diagnosis:

• *First-line:* The classic definition is a *temperature of 38°C (100.4°F) or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours*.
• *Gold Standard:* Blood cultures, endometrial cultures, and CBC.

Management:

• *Acute:* Obtain cultures and initiate broad-spectrum IV antibiotics (e.g., Clindamycin and Gentamicin).
• *Definitive:* Supportive care, hydration, antipyretics, and monitoring for complications like pelvic abscess or septic pelvic thrombophlebitis.