Postpartum Confusion in a Primip

Clinical Presentation

A 30-year-old, G1P1 black woman presents to the emergency department 4 days after an uncomplicated vaginal delivery. She has no significant medical history and was discharged 2 days ago in stable condition. Her father reports that she has been "acting strangely" for the past day and feels warm to the touch. Upon examination, she is aware that she is in a hospital and complains of "aches all over," but cannot answer any other questions properly.

Physical Examination

Vital signs are significant for a temperature of 101.0°F, heart rate of 100 bpm, and blood pressure of 110/60 mm Hg. Vaginal bleeding is minimal and without odor, and her uterine fundus is palpable midway between her umbilicus and pubic symphysis. No uterine tenderness is appreciated, although she continues to complain of diffuse pain. Extremely dark-colored urine is noted by nursing staff. The rest of the physical exam is normal.

Laboratory results show:

Hemoglobin: 4.5 g/dL
Platelet count: 15,000 x 10³ µL
WBC count: 10.3/mm³ with no left shift
Creatinine: 1.0 mg/mL
AST: 14 IU/L
LDH: 2000 IU/L
Coagulation profile and fibrinogen: normal

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Cite this: Postpartum Confusion in a Primip - Medscape - Feb 28, 2011.