Page 1

Mrs. Puri, a 28-year-old lady came to the postpartum ward at a hospital due to
fever and vaginal bloody discharge. She delivered her first child assisted by a
traditional birth attendant 4 days ago. She had some fever since yesterday. She
said that the temperature had reached 39.1oC. The fever was not relieved even after
she took paracetamol 3x500 mg.

She said that some bloody discharge was still draining out through her vagina and
it smelt foul. Moreover, she felt that whenever she breastfeeds her baby, she gets
awful tummy cramps. She thought the milk did not come down yet.

Instructions
1. IDENTIFY THE PATIENT’S PROBLEM!
2. Why did she develop a fever?
3. Is it normal to have bloody discharge after delivery? Why?
4. How would you consider it normal and when it is considered abnormal?
3. Why did the discharge smell foul?
4. Why did whenever she breastfeeds her baby, she felt awful tummy cramps?
5. When should the milk come out? how?
6. What was wrong with her breast?
7. GENERATE A LIST OF HYPOTHESES FOR EACH PROBLEM!
8. WHAT FURTHER INFORMATION AND INVESTIGATIONS MAY BE HELPFUL FROM MRS. PURI?