| Course | NU684 Obstetrical Care |
|---|---|
| Unit | Unit 9 |
| Paper type | Postpartum infection case analysis |
| Length | About 1,100 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU684 Unit 9
A Fever on Day Two: A Unit 9 Postpartum Infection Case Analysis of Endometritis After a Cesarean in Labor
[Student Name]
Purdue University Global
NU684: Obstetrical Care
Unit 9 Postpartum Infection Case Analysis
[Instructor Name]
[Date]
The patient and values are composite and illustrative; the sources cited are real.
The Case
Ms. Delacroix is para 1, delivered by cesarean at 40 weeks 3 days for arrest of dilation at 6 centimeters after 19 hours of labor. Her membranes had been ruptured for 17 hours, she had seven cervical examinations and an internal monitor was placed. She received cefazolin before the incision, as is standard. She did not receive azithromycin, which the hospital does not routinely give. Her group B streptococcus screen was negative.
On postoperative day 2 she reports chills, lower abdominal pain beyond her incisional soreness and a foul smell to her bleeding. Her temperature is 38.9 degrees Celsius, pulse 116, blood pressure 108/64, respiratory rate 20 and oxygen saturation 98 percent. Her uterus is tender on palpation, the lochia is malodorous, and the incision is clean and dry. Her lungs are clear, her breasts are soft, her calves are not tender and she has no urinary symptoms. White blood cell count is 19,000 per microliter, lactate 1.6 mmol/L.
The Differential
Fever after a cesarean has several causes, and the analysis considers each against her findings.
Endometritis, infection of the uterine lining, is the most common cause of fever after cesarean, especially after a long labor, prolonged rupture of membranes and multiple examinations. Her uterine tenderness and foul lochia fit.
Wound infection usually appears later, around days 4 to 7, with redness, warmth or drainage; her incision is clean.
Urinary tract infection is common after catheterization; a urinalysis and culture are sent.
Pneumonia or atelectasis is considered after anesthesia; her lungs are clear and her oxygen saturation normal.
Mastitis is unlikely this early, and her breasts are soft.
Venous thromboembolism can cause fever; her calves are normal and she has no shortness of breath.
Septic pelvic thrombophlebitis is considered if fever persists despite appropriate antibiotics.
Group A streptococcal infection deserves mention because it can progress rapidly to sepsis and toxic shock after birth; severe pain out of proportion to findings, low blood pressure or rash would raise concern.
Her history of a long labor, many examinations and hours of ruptured membranes made endometritis the expected diagnosis before she was examined.
Sepsis Screen
Her pulse and temperature meet criteria for screening, so blood cultures are drawn and lactate is measured before antibiotics. A lactate of 1.6 and stable blood pressure are reassuring, but she is reassessed every four hours for any signs of deterioration, including falling blood pressure, rising lactate, confusion or reduced urine output.
Choosing Antibiotics
Endometritis after cesarean is usually polymicrobial, involving aerobic and anaerobic bacteria from the vagina, and coverage of anaerobes matters. A Cochrane review of 40 trials found that clindamycin plus an aminoglycoside led to fewer treatment failures than penicillin-based regimens, that regimens with poor activity against penicillin-resistant anaerobes had more failures and wound infections, and that once-daily gentamicin had fewer failures than thrice-daily dosing (Mackeen et al., 2015).
Ms. Delacroix receives clindamycin 900 milligrams intravenously every eight hours and gentamicin 5 milligrams per kilogram intravenously once daily. Both are compatible with breastfeeding. Antibiotics continue until she has been fever free and her pain has improved for 24 to 48 hours; oral antibiotics afterward are not needed for uncomplicated endometritis.
If she has not improved after 48 to 72 hours, ampicillin is added to cover enterococcus, and imaging is ordered to look for a pelvic abscess, an infected hematoma or retained products. Persistent fever without a collection would raise the question of septic pelvic thrombophlebitis.
Her Course
Her temperature falls to 37.6 within 36 hours and her pain eases. Her urine culture is negative. After 48 hours without fever, antibiotics are stopped, and she is discharged on day 5. She is told to return for fever, worsening pain, heavy or foul-smelling bleeding, wound redness or drainage, or feeling faint.
Her Baby and Breastfeeding
Ms. Delacroix was worried that the infection or the antibiotics would harm her son, who was rooming in and breastfeeding well. She was told that endometritis does not spread to the baby through breastfeeding, that clindamycin and gentamicin pass into milk only in small amounts and are compatible with nursing, and that the main thing to watch in the baby was loose stools or a diaper rash, which can occur when a nursing parent takes antibiotics. The pediatric team was informed. Because fever and pain can make feeding harder, a lactation nurse helped her find a side-lying position that kept pressure off her incision, and her partner took over diaper changes and settling at night so she could rest while the antibiotics worked.
What She Was Told
The clinician explained the diagnosis in plain terms: bacteria that normally live in the vagina had reached the lining of the uterus during the long labor, which is a known risk after many hours of ruptured membranes and several examinations, not a sign that anything was done wrong. She was told how the antibiotics would be given, how long they would likely be needed and what would happen if she did not improve. She asked whether this would affect future pregnancies; she was told that uncomplicated endometritis treated promptly does not usually affect fertility.
Could It Have Been Prevented?
ACOG recommends antibiotic prophylaxis before the skin incision for every cesarean, which she received (American College of Obstetricians and Gynecologists [ACOG], 2018). For cesareans done during labor or after membranes rupture, adding azithromycin further reduces infection. In a randomized trial of more than 2,000 women having nonelective cesareans, adjunctive azithromycin halved the composite of endometritis, wound infection and other infections, 6.1 percent compared with 12.0 percent, and also reduced serious maternal adverse events (Tita et al., 2016). ACOG's practice bulletin notes adjunctive azithromycin as an option for these patients.
Ms. Delacroix met the trial's criteria. Her case is therefore reported to the unit's quality committee with a recommendation to add adjunctive azithromycin to the standing order set for cesareans in labor or after rupture of membranes, a change that could prevent about half of infections like hers.
Conclusion
Ms. Delacroix's fever on day 2 after a cesarean in labor was most likely endometritis, and her examination supported it. Screening for sepsis, testing other sources and starting clindamycin with once-daily gentamicin followed the evidence, and she recovered promptly. Reviewing her case against the azithromycin trial points to a unit change that could prevent similar infections.
References
American College of Obstetricians and Gynecologists. (2018). ACOG practice bulletin no. 199: Use of prophylactic antibiotics in labor and delivery. Obstetrics & Gynecology, 132(3), e103-e119. https://doi.org/10.1097/AOG.0000000000002833
Mackeen, A. D., Packard, R. E., Ota, E., & Speer, L. (2015). Antibiotic regimens for postpartum endometritis. Cochrane Database of Systematic Reviews, 2015(2), Article CD001067. https://doi.org/10.1002/14651858.CD001067.pub3
Tita, A. T. N., Szychowski, J. M., Boggess, K., Saade, G., Longo, S., Clark, E., Esplin, S., Cleary, K., Wapner, R., Letson, K., Owens, M., Abramovici, A., Ambalavanan, N., Cutter, G., & Andrews, W. (2016). Adjunctive azithromycin prophylaxis for cesarean delivery. New England Journal of Medicine, 375(13), 1231-1241. https://doi.org/10.1056/NEJMoa1602044
The Purdue Global NU684 Unit 9 instructions
The ninth unit commonly presents a fever or infection after birth and asks for a case analysis from differential to treatment and prevention. Prompts usually want the history and risk factors, a differential that considers each source of postpartum fever, a sepsis assessment, the antibiotic choice with evidence, the expected course and what would prompt further investigation, and how the infection might have been prevented. Breastfeeding compatibility and patient counseling are often expected. Instructors reward analyses that rule sources in or out with specific findings and that treat sepsis screening as standard rather than optional. Sources typically include a systematic review of treatment regimens, ACOG's guidance on prophylactic antibiotics and a trial supporting any prevention change proposed. Some prompts close by asking for a recommendation to unit practice.
How this NU684 Unit 9 example is built
The Delacroix analysis lists her labor details, prophylaxis and findings on day two. The differential considers seven sources and weighs each against her examination, with a highlighted line noting that her labor history predicted endometritis. A sepsis screen with blood cultures and lactate, marked by a margin note, comes before antibiotics. The treatment section reports Mackeen and colleagues' findings on clindamycin with gentamicin and once-daily dosing, sets the regimen and duration, and explains the next steps if she does not improve. Her course is summarized. A section on her baby and breastfeeding answers her worries, and another explains the diagnosis to her. The prevention section applies ACOG's prophylaxis bulletin and Tita and colleagues' azithromycin trial, ending with a recommendation to the quality committee, which a second margin note highlights.
Reading the NU684 Unit 9 grading rubric
Postpartum infection analyses are scored on the completeness of the differential, sepsis assessment, evidence-based treatment, planning for nonresponse, patient and infant considerations, and prevention. The differential earns credit when each source is addressed with findings, not just named. Sepsis assessment is expected for any febrile postpartum patient with a raised pulse. Treatment marks require a regimen supported by evidence, with dose, route and duration, and a note that oral antibiotics are not needed after uncomplicated endometritis. Planning for nonresponse, including added coverage and imaging, shows depth. Graders look for breastfeeding compatibility and clear counseling. The prevention section is often what separates good analyses from strong ones, especially when it connects an individual case to unit practice. Organized headings and APA references for the review, the prophylaxis bulletin and the trial complete the rubric.
Common NU684 Unit 9 mistakes, and how to avoid them
Analyses lose marks most often when they jump to endometritis without considering other sources of fever, or when they skip the sepsis screen. Another frequent error is choosing a regimen with poor anaerobic coverage, or continuing oral antibiotics after discharge without a reason. Some papers give no plan for a patient who does not improve within 72 hours, missing abscess and septic pelvic thrombophlebitis. Others leave the nursing question unanswered or wrongly advise stopping. Prevention is sometimes limited to a general comment about prophylaxis without checking what the patient actually received. Begin with a two-column list: each postpartum fever source, and the finding in your patient that argues for or against it. Then check what prophylaxis was given. Your patient's vital signs, findings and prompt are enough to start a custom endometritis analysis.
Get an NU684 Unit 9 example written to your instructions
Send the case, the vital signs and findings, and the analysis instructions with the rubric. A custom analysis works the differential, chooses antibiotics and reviews how the infection might have been prevented. The first is free, back within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU684 Unit 9 questions, answered
What is the usual treatment for postpartum endometritis?
Intravenous clindamycin plus gentamicin is a common and effective regimen, continued until the patient has been fever free for about 24 to 48 hours. Oral antibiotics afterward are usually unnecessary.
How is endometritis after cesarean prevented?
Antibiotics before the skin incision, and for cesareans during labor or after membranes rupture, adding azithromycin reduces infections further.
What else causes fever after birth?
Urinary infection, wound infection, mastitis, pneumonia and blood clots, among others. A case analysis should rule these in or out.
Where can I find a free NU684 Unit 9 sample paper?
The complete NU684 Unit 9 postpartum infection case analysis is on this page. It works a day-two fever after a cesarean in labor through the differential and a sepsis screen to clindamycin with gentamicin, and recommends adjunctive azithromycin for the unit.
How might the NU684 Unit 9 infection have been prevented?
She received standard cefazolin before her incision but not azithromycin. In a large trial of cesareans done in labor or after membranes ruptured, adding azithromycin halved infections, so the analysis recommends adding it to the unit's order set.