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A 23-year-old female patient is being evaluated for postpartum fever for the past 7 days. She delivered vaginally a healthy infant and placenta was delivered spontaneously. On the 6th day postpartum, she developed a persistent spiking fever. On examination no placental remnants were found in the uterus. A combination of clindamycin and gentamycin was started a week ago without any response. When asked about her breastfeeding, she says that it’s not causing her any discomfort. Urinalysis is normal and abdominal as well as pelvic ultrasonogram reveals nothing abnormal. Her vitals are: BP of 120/80 mm Hg, PR of 98/min and temperature of 39°C. What is the most appropriate next step in management?

A. CT scan
B. Laparotomy
C. Heparin therapy
D. Change antibiotic combination
E. Surgical drainage


it can be an abcess i will choose surgical drainage


had no idea what was correct... but i just came across this answer today while doing ob/gyn questions...
C - heparin therapy
According to usmleworld - pelvic thrombophlebitis is a diagnosis of exclusion and should be suspected in any patient who present with unexplain postpartum fever for 7-10 days despite antibiotic therapy. When suspected treat with heparin. Rapid response should be noted.



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