Infection after birth: endometritis, wound, breast and urinary infection; signs and nursing care

What it is

Infection after birth can progress to sepsis, a medical emergency. Res. 3280 de 2018 asks staff to watch for fever, tachycardia, tachypnoea, a tender uterus and foul lochia, and, when there is fever, to look for the source: urinary tract, surgical wound, breast, uterus, pelvic veins, a drug reaction or the episiotomy. The nurse measures, examines and records, uses clean and aseptic technique, gives the treatment ordered on time and recognises sepsis early. Sepsis is a medical emergency.

Reference values

• Endometritis: fever or chills, lower abdominal pain, a tender uterus and foul-smelling lochia (WHO).
• Mastitis: one breast, a red wedge-shaped area, pain and fever, often three to six days after birth; a fluctuant swelling suggests an abscess (WHO).
• Wound infection: unusual pain and tenderness, redness and swelling beyond the edge of the incision, or pus.
• Urinary infection: pain on urination, frequency and urgency; flank pain and high fever suggest kidney infection.
• Deep vein thrombosis can also cause fever: swelling and tenderness of one leg.

What you need

• Thermometer, early warning chart and a clock to count breathing.
• Clean gloves, sterile dressing supplies and good light.
• Sample containers as ordered (urine, blood cultures, wound swab).
• The institution's sepsis protocol.

How to measure it (and why)

1. Measure temperature, pulse, pressure, breathing and consciousness, and score the warning scale — sepsis can worsen fast.
2. Score the qSOFA criteria of Res. 3280 — with two or more, call the doctor at once.
3. Palpate the uterus and look at the lochia: tenderness, smell and colour — they point to endometritis.
4. Inspect the wound or perineum with aseptic technique: redness, swelling, discharge, gaps — the wound is a frequent source after caesarean.
5. Examine both breasts: red area, lump, warmth or fluctuation — mastitis affects one breast; engorgement, both.
6. Ask about urinary symptoms and look at both legs — they are other frequent sources of fever.
7. Take ordered samples before the first antibiotic if the protocol says so, and give the antibiotic on time — early sepsis treatment works best.
8. For mastitis, help her keep breastfeeding, with a supportive bra and the comfort measures ordered — WHO advises continuing to breastfeed.
9. Wash hands before and after each contact and change pads and dressings with clean technique — this prevents new infections.
10. Repeat vital signs as the protocol says and record the trend — fever that persists despite antibiotics needs a new review.

Fever after birth: likely source by its signs (WHO, own summary)

How to read it

• Swollen, hard breasts on both sides a few days after birth are usually engorgement, not infection.
• Fever in the first 24 hours is not counted as postpartum fever by Res. 3280, but it is still recorded and reported.
• Res. 3280 asks staff to think of misoprostol as a cause of fever when it has been given.
• Sepsis signs from WHO: fever or low temperature with shivering, confusion, breathlessness, clammy skin, fast heart rate, low blood pressure and little urine.

Next step: when to call for help

• Call at once if two qSOFA criteria are present, or if she is confused, breathless, cold and clammy or passing little urine.
• Call for fever above 38 °C after the first 24 hours with a tender uterus or foul lochia.
• Call for a wound with pus, spreading redness or opening.
• Call for a red, hot breast with high fever or a fluctuant lump.
• Call if fever persists despite antibiotics.

Test yourself

Think of the answer, then tap the question to see it.

Add to my cards (4)

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Managing complications in pregnancy and childbirth: a guide for midwives and doctors, 2nd ed. (World Health Organization, 2017); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Endometritis (MedlinePlus, U.S. National Library of Medicine, 2025); Sepsis (fact sheet) (World Health Organization, 2024).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Send

Representative model, for educational purposes only.