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Development of the typical clinical features, especially fever within 48 hours after delivery, suggests a diagnosis of puerperal infection. Uterine tenderness is also highly suggestive.
A culture of lochia, incisional exudate (from cesarean incision or episiotomy), uterine tissue, or material collected from the vaginal cuff that reveals the causative organism may confirm the diagnosis, but such cultures are generally contaminated with vaginal flora and aren’t considered helpful.
Within 36 to 48 hours, white blood cell count usually demonstrates leukocytosis (15,000 to 30,000/µl).
Typical clinical features usually suffice for diagnosis of endometritis and peritonitis. In parametritis, pelvic examination shows induration without purulent discharge.
Diagnosis of pelvic or femoral thrombophlebitis is suggested by characteristic clinical signs, venography, Doppler ultrasonography, palpable veins inside the thigh and calf, pain in the calf when pressure is applied on the inside of the foot, and pain on passive dorsiflexion of the foot with the knee extended (Homans’sign). Homans’ sign should be elicited passively by asking the patient to dorsiflex the foot. Active dorsiflexion could lead to embolization of a clot.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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