Abstract
(N Engl J Med. 2022;387:2367–2375) This case presented 15 days after the patient’s vaginal delivery of a healthy baby, when she was admitted to the hospital with abdominal pain and fever. Sixteen days prior, spontaneous labor had been augmented by artificial membrane rupture (showing clear, odorless fluid) and oxytocin infusion. An elevated white-cell count was noted (13,800/mL, 4500 to 11,000/mL reference range) and intravenous penicillin was administered. Hemoglobin was noted to be 14.0 g/dL (12.0 to 16.0 g/dL reference range). Delivery occurred 6 hours later, followed immediately by uterine atony hemorrhage with 500 mL of blood loss. Hemostasis was achieved by bimanual massage of the uterus, and administration of oxytocin and methylergonovine. A routine repair of a perineal laceration was also performed. The patient discharged from the hospital on postpartum day 1.
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