A common cause of uterine tenderness and fever in a patient who underwent a cesarean section is:

• A. Endometritis
• B. Pelvic inflammatory disease
• C. Urinary tract infection
• D. Wound infection

Answer: (A)

Endometritis is the infection of the uterine lining that most commonly follows cesarean delivery. The uterus is opened during surgery, allowing vaginal bacteria to ascend into the endometrium. This leads to fever and uterine tenderness in the immediate postpartum period, often with foul-smelling lochia and tachycardia. The infection is typically polymicrobial, involving anaerobes and gram-negative organisms. Treatment requires broad-spectrum IV antibiotics that cover both aerobes and anaerobes (for example, clindamycin plus gentamicin, with adjustments as needed). Other postpartum infections, like a urinary tract infection, wound infection, or pelvic inflammatory disease, don’t usually present with the same combination of uterine tenderness and postpartum fever in this context, making endometritis the most likely diagnosis after a C-section.