system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
Three days after delivering a baby at 36 weeks' gestation by lower segment transverse cesarean section due to abruptio placentae, a 29-year-old primigravid woman develops fever, chills, and a heavy feeling in her breasts. She also has nausea and abdominal pain. Her temperature is 39.3°C (102.7°F), pulse is 101/min, and blood pressure is 110/70 mm Hg. Examination shows full and tender breasts and mild lower limb swelling. Abdominal examination shows diffuse tenderness with no guarding or rebound. Pelvic examination shows foul-smelling lochia and marked uterine tenderness. Laboratory studies show:
Hemoglobin 11.3 g/dL
Leukocyte count 16,300/mm3
D-dimer 130 ng/mL(N < 250 ng/mL)
Serum
Creatinine 1.2 mg/dL
Pelvic ultrasonography shows an empty uterus. Which of the following is the most appropriate next step in management?"
assistant
IV clindamycin and gentamicin