A 28-year-old woman who underwent a cesarean delivery 1 week ago is brought into the emergency room with a blood pressure of 60/40 mmHg. The patient’s husband states that she had 2 days of nausea and vomiting, fever to 102°F (38.8°C), and myalgias. The reason for the cesarean was arrest of active phase, with cervical dilation at 5 cm for 3 hours despite strong uterine contractions. She was discharged home on postoperative day 3 in good condition. On examination, the patient appears lethargic and has mental confusion. Auscultation of her heart reveals tachycardia.
The lung examination demonstrates slight crackles at the lung bases. The abdomen is tender throughout, and the fundus of the uterus is slightly tender. The skin incision is tender, red, and indurated. Upon opening the incision, purulent material is expressed. The underlying tissue is palpated and has a brawny texture with…
