Puerperium: septic pelvic thrombophlebitis: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Puerperium: septic pelvic thrombophlebitis

Sample item

A woman 5 days after caesarean for obstructed labour has persistent spiking fever despite 72 hours of broad-spectrum intravenous antibiotics. She feels reasonably well, and pelvic examination, ultrasound and CT show no collection. What is the most likely diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Septic pelvic thrombophlebitis; add therapeutic anticoagulation to antibiotics

Septic pelvic thrombophlebitis is a diagnosis of exclusion in a postpartum woman with persistent fever despite antibiotics and no abscess, caused by infected thrombus in pelvic veins, mainly the ovarian veins. Treatment is continued antibiotics with heparin, and defervescence on heparin supports the diagnosis. Imaging may show an ovarian vein thrombus but is not always positive.

Option by option

  • A. Urinary tract infection; give nitrofurantoin

    A urinary infection would not explain the picture described.

  • B. Septic pelvic thrombophlebitis; add therapeutic anticoagulation to antibiotics (correct)

    Correct. Persistent fever without a collection, despite antibiotics, suggests infected pelvic vein thrombosis, treated with heparin.

  • C. Drug fever; stop antibiotics

    Stopping antibiotics risks untreated infection.

  • D. Pelvic abscess needing laparotomy

    The imaging shows no abscess, so laparotomy is not indicated.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Septic pelvic thrombophlebitis; add therapeutic anticoagulation to antibiotics. Septic pelvic thrombophlebitis is a diagnosis of exclusion in a postpartum woman with persistent fever despite antibiotics and no abscess, caused by infected thrombus in pelvic veins, mainly the ovarian veins.

Why is "Urinary tract infection; give nitrofurantoin" not the answer?

A urinary infection would not explain the picture described.

Why is "Drug fever; stop antibiotics" not the answer?

Stopping antibiotics risks untreated infection.

Why is "Pelvic abscess needing laparotomy" not the answer?

The imaging shows no abscess, so laparotomy is not indicated.

What concept does this question test?

It tests Puerperium: septic pelvic thrombophlebitis in OBG. Treatment is continued antibiotics with heparin, and defervescence on heparin supports the diagnosis. Imaging may show an ovarian vein thrombus but is not always positive.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Puerperium: septic pelvic thrombophlebitis?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.