Differential Diagnosis for Postpartum Fever
The patient's presentation of fever, chills, and abdominal pain on the postpartum floor, following an emergency cesarean delivery, suggests several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Surgical Site Infection (SSI): The presence of induration and erythema extending from the incision site to the mons pubis, along with fever, strongly suggests a surgical site infection. This is a common complication following cesarean deliveries, especially when the surgery is performed under emergency conditions or when there is prolonged labor, which may increase the risk of infection.
Other Likely Diagnoses
- Endometritis: Although the uterine fundus is described as nontender, endometritis remains a consideration, especially given the history of prolonged labor and emergency cesarean delivery. The absence of uterine tenderness does not rule out endometritis, as it can sometimes present with minimal uterine findings.
- Urinary Tract Infection (UTI): The patient has a Foley catheter in place, which increases the risk of UTI. The presence of blood-tinged urine and trace blood on urinalysis, despite negative leukocyte esterase and nitrites, could suggest a UTI, although the lack of positive urine tests makes this less likely.
- Breast Engorgement/Mastitis: While the breasts are engorged and tender, the absence of erythema makes mastitis less likely. However, it cannot be entirely ruled out without further evaluation.
Do Not Miss Diagnoses
- Septic Pelvic Thrombophlebitis: This is a rare but potentially life-threatening condition that can occur postpartum, especially after cesarean delivery. It presents with fever, pelvic pain, and sometimes abdominal tenderness, which can be similar to other postpartum infections.
- Necrotizing Fasciitis: Although rare, this condition is a medical emergency. The presence of significant erythema and induration extending beyond the incision site could be indicative of necrotizing fasciitis, which requires immediate surgical intervention.
Rare Diagnoses
- Ovarian Vein Thrombosis: This condition can present with abdominal pain and fever in the postpartum period. It is more common after cesarean delivery but is still a rare occurrence.
- Puerperal Invasive Group A Streptococcal Infection: This is a rare but severe infection that can occur postpartum, characterized by high fever, severe pain, and sometimes a history of recent infection or colonization with group A streptococcus.