Postpartum Infections

A postpartum temperature of 38°C on day one might be dehydration. The same fever on day two or three with a foul-smelling lochia points to endometritis — the most common postpartum infection and one you need to catch fast.

Postpartum infection (puerperal infection) is defined as a temperature of 38°C (100.4°F) or higher on any two of the first ten postpartum days, excluding the first 24 hours. The most common site is the uterine lining — endometritis — which presents with uterine tenderness, boggy uterus, foul-smelling lochia, tachycardia, and fever typically appearing 48–72 hours after delivery. Risk factors include cesarean birth (single greatest risk factor), prolonged rupture of membranes (>18 hours), multiple vaginal exams during labor, retained placental fragments, and maternal anemia or diabetes. Wound infections (cesarean incision or episiotomy) present with localized redness, warmth, edema, and purulent drainage. Mastitis typically appears 2–4 weeks postpartum with unilateral breast redness, warmth, and flu-like symptoms — distinguished from engorgement, which is bilateral and occurs earlier. Urinary tract infections are common due to catheterization during labor. Nursing priorities include monitoring temperature trends, assessing lochia character and odor every shift, administering prescribed broad-spectrum antibiotics (often IV clindamycin plus gentamicin for endometritis), encouraging Fowler's position to promote lochia drainage, and maintaining hand hygiene and perineal care education.

Key Distinctions

Don't confuse normal lochia odor (fleshy, not foul) with infected lochia (malodorous, purulent). Students mix up endometritis (uterine infection with systemic fever) and wound infection (localized incision signs without necessarily high fever early on). Mastitis is unilateral and occurs weeks later — bilateral breast fullness on day 3 is engorgement, not infection.

Clinical Pearl

If it smells wrong, it IS wrong. Foul lochia plus fever after the first 24 hours equals endometritis until proven otherwise — position the patient in Fowler's to let gravity drain the infected uterus.