A 41-year-old G5, P5 woman has noticed lower abdominal pain with fever for the past 2 days. She delivered a normal term infant 1 week ago. On examination, she has a temperature of 37.4degC. There is a foul-smelling vaginal discharge. Which of the following pathologic findings is she most likely to have?

## **Core Concept**
The patient presents with symptoms of lower abdominal pain, fever (although her temperature is within normal limits at the time of examination), and foul-smelling vaginal discharge 1 week postpartum. These symptoms are suggestive of a postpartum infection, specifically endometritis, which is an inflammation of the endometrium often caused by infection.

## **Why the Correct Answer is Right**
The correct answer, , is indicative of endometritis, which is a common postpartum complication. Endometritis is often caused by bacterial infection, which can ascend from the lower genital tract. The symptoms of endometritis include uterine tenderness, fever (which may not always be present), and foul-smelling lochia. The presence of foul-smelling vaginal discharge and lower abdominal pain in this patient, who is 1 week postpartum, makes endometritis a likely diagnosis.

## **Why Each Wrong Option is Incorrect**
- **Option A:** - This option does not directly relate to the clinical presentation of postpartum endometritis or common pathologic findings associated with it.
- **Option B:** - This option might suggest another condition but does not align with the clinical scenario provided, which points more towards an infectious process like endometritis.
- **Option C:** - This option could potentially represent another pathologic condition but does not fit the clinical presentation as well as the correct answer.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that endometritis is a leading cause of postpartum morbidity. It is often associated with a polymicrobial infection involving both aerobic and anaerobic bacteria. The presence of foul-smelling lochia (or discharge) and uterine tenderness are critical clinical findings that support the diagnosis of endometritis.

## **Correct Answer:** . Endometritis

✓ Correct Answer: B. Endometrial neutrophilic infiltrates