A postpartum patient presents with fever, foul-smelling lochia, and abdominal tenderness. What is the likely diagnosis and the proposed treatment?

• A. Endometritis; treat with broad-spectrum IV antibiotics and supportive care.
• B. Uterine atony; treat with oxytocin.
• C. Preeclampsia; treat with magnesium sulfate.
• D. Mastitis; treat with warm compresses.

Answer: (A)

Postpartum endometritis is an infection of the uterine lining that typically presents with fever, foul-smelling lochia, and uterine tenderness. The foul odor and localized abdominal tenderness reflect infection of the endometrium, and fever shows systemic inflammation, making this presentation classic for endometritis in the postpartum period. Prompt treatment with broad-spectrum IV antibiotics is necessary to cover both aerobic and anaerobic organisms commonly involved, along with supportive care such as fluids and fever management. This approach helps prevent progression to sepsis and other complications. The other conditions don’t fit this picture: uterine atony causes heavy bleeding with a boggy uterus rather than foul lochia; preeclampsia features hypertension, proteinuria, and edema and is managed with magnesium sulfate and blood pressure control rather than antibiotics; mastitis involves the breast, presenting with breast pain or redness rather than foul lochia or uterine tenderness.