A patient presents for routine postpaum examination 2 weeks after a normal vaginal delivery with complains of foul smelling vaginal discharge with fever. On abdominal examination, a tender 14 weeks uterus is palpable, breast examination is normal and episiotomy is healthy. What could be the possible diagnosis?

**Core Concept:** In postpartum patients, foul smelling vaginal discharge accompanied by fever can be indicative of an infection, particularly if there is a tender uterus palpated on abdominal examination.

**Why the Correct Answer is Right:** In this case, the patient presents with postpartum complications that include foul smelling vaginal discharge and fever. These symptoms are suggestive of an infection, specifically an endometritis or puerperal pyrexia, which is an infection of the uterus following childbirth. The tender uterus palpated during abdominal examination further strengthens the suspicion of an infection.

**Why Each Wrong Option is Incorrect:**

A. **Option A (Vaginal discharge without fever)**: The presence of fever is crucial in this scenario, as it indicates bacterial or viral infection and supports the diagnosis.

B. **Option B (Normal breast examination)**: Although breast examination is normal, the patient still presents with fever and other symptoms indicative of infection, making this option less likely but not entirely incorrect.

C. **Option C (Healthy episiotomy)**: The episiotomy status is not directly related to the patient's symptoms, as the focus should be on the uterine infection and systemic symptoms.

D. **Option D (No abdominal tenderness)**: The patient does have abdominal tenderness during abdominal examination, which is supportive of an infection.

**Possible Diagnosis:** The correct diagnosis in this case is **Option C (Puerperal pyrexia)**. Puerperal pyrexia, also known as endometritis, occurs in the postpartum period due to bacterial or viral infections of the uterus. The combination of fever, foul smelling vaginal discharge, and tender uterus supports this diagnosis.

✓ Correct Answer: D. Subinvolution of the uterus