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

- Assessment

Fever after the first day postpartum needs a search for its source: uterus, wound, breasts, urine or legs. Signs of sepsis need urgent help.

Updated Nov 13, 2026

## Key points

- Postpartum fever: above 38 °C after the first 24 hours (Res. 3280).
- Probable sepsis in Res. 3280 (qSOFA): two or more of altered consciousness (Glasgow 13 or less), breathing 22 per minute or more and systolic pressure 100 mmHg or less.
- Endometritis is more common after a caesarean or a long labour (MedlinePlus).
- With mastitis the woman keeps breastfeeding (WHO).
- Hand hygiene and clean or aseptic technique at every contact prevent infection.

## 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)

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

| Source | Signs that point to it |
| --- | --- |
| Uterus (endometritis) | Fever or chills, lower abdominal pain, tender uterus, foul lochia |
| Breast (mastitis or abscess) | One breast painful, red wedge-shaped area, fever; a fluctuant lump suggests an abscess |
| Wound | Unusual tenderness, redness and swelling beyond the edge, discharge or pus |
| Urinary tract | Pain on urination, frequency and urgency; flank pain with high fever |
| Leg veins | Swelling, warmth and tenderness of one leg |

## 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.

## Which three criteria make up the qSOFA used in Res. 3280?

Altered consciousness (Glasgow 13 or less), breathing 22 per minute or more and systolic pressure 100 mmHg or less.

## After which kinds of birth is endometritis more common?

After a caesarean or a long labour.

## Should a woman with mastitis stop breastfeeding?

No. WHO advises her to continue breastfeeding.

## What three signs typically suggest endometritis?

Fever with lower abdominal pain, a tender uterus and foul-smelling lochia.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/infection-after-birth-endometritis-wound-breast-and-urinary-infection-signs-and/)

## Connections

## Related 3

- [The postpartum assessment: uterus, lochia, perineum, breasts, bladder, legs, mood and bonding](https://durgical.com/en/nursing/the-postpartum-assessment-uterus-lochia-perineum-breasts-bladder-legs-mood-and-b/)
- [The surgical wound: healing, dehiscence and infection](https://durgical.com/en/nursing/the-surgical-wound-healing-dehiscence-and-infection/)
- [Preventing healthcare-associated infections: the care bundles](https://durgical.com/en/nursing/preventing-healthcare-associated-infections-the-care-bundles/)

## Related conditions 4

- [Puerperal infection (postpartum endometritis and maternal sepsis)](https://durgical.com/en/conditions/puerperal-infection/)
- [Acute mastitis](https://durgical.com/en/conditions/acute-mastitis/)
- [Breast abscess](https://durgical.com/en/conditions/breast-abscess/)
- [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/)

[← All of nursing](https://durgical.com/en/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.](https://iris.who.int/server/api/core/bitstreams/3bda1306-da5d-487d-b2ad-aff995112a7a/content) (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](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [Endometritis](https://medlineplus.gov/ency/article/001484.htm) (MedlinePlus, U.S. National Library of Medicine, 2025); [Sepsis (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/sepsis) (World Health Organization, 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/infection-after-birth-endometritis-wound-breast-and-urinary-infection-signs-and/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/infection-after-birth-endometritis-wound-breast-and-urinary-infection-signs-and/