A woman delivered at home two days ago develops sudden high fever, tachycardia, hypotension, and a rapidly spreading area of uterine tenderness with scant foul lochia. Blood pressure falls despite fluids over the next few hours. Which organism is classically responsible for this fulminant form of puerperal sepsis?

• A Escherichia coli
• B Group B Streptococcus
• C Chlamydia trachomatis
• D Group A beta-haemolytic Streptococcus ✓

Explanation

Group A beta-haemolytic Streptococcus (Streptococcus pyogenes) is the most virulent cause of puerperal sepsis, historically producing the fulminant childbed fever deaths of the pre-antiseptic era. It causes rapid necrotising endomyometritis with early shock out of proportion to local findings. E. coli and other anaerobes are more common but generally less fulminant, and Chlamydia produces late, indolent postpartum endometritis.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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