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Clinical case review

A woman with a postpartum genital tract infection

Iris Wang

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Abstract

A woman presenting nine weeks after a caesarean section is afrebile but has a tender uterus on examination. A vaginal swab is positive for Haemophilus influenzae. How should she be managed?

Article Extract

Case scenario

Rebecca is 33 years of age and presents nine weeks postpartum with her third child, who was born, as were her other two babies, by caesarean section. She is breastfeeding successfully, and her vaginal bleeding and discharge had ceased by five weeks after the birth. Rebecca has not yet resumed sexual activity. Over the few days before her consultation she had a recurrence of blood-tinged vaginal discharge associated with what she described as a ‘niggling and intermittent discomfort’ in her lower abdomen. Rebecca feels tired, but is afebrile. Bimanual palpation reveals a tender uterus, and a swab of her vaginal discharge produces a heavy and unexpected growth of Haemophilus influenzae.

Is Rebecca likely to have acquired this infection at the time of the caesarean section? What is the best way to manage her infection?

Picture credit: © Phototake Inc./Diomedia.com. Haemophilus influenzae culture.

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