Which symptom is most indicative of endometritis after cesarean birth?

• A. Fever
• B. Uterine tenderness with foul lochia
• C. Shortness of breath
• D. Nausea

Answer: (B)

Endometritis is an infection of the uterine lining that most often follows cesarean birth. The best clue is a combination of uterine tenderness on abdominal exam and foul-smelling lochia. This foul discharge indicates infected decidual tissue and endometrium, while tenderness reflects the inflammatory process in the uterus. Fever can occur with infection but is not specific to endometritis and can be caused by many postpartum issues. Shortness of breath points more toward a pulmonary concern like a PE or pneumonia, and nausea is nonspecific. So the presence of uterine tenderness with foul lochia most directly signals endometritis and prompts prompt treatment with antibiotics.