Postpartum Fever

First actions / assessment

• Assess ABCDE first and think sepsis early. Clarify postpartum day, mode of delivery, prolonged rupture of membranes, operative delivery, perineal trauma/episiotomy, retained placenta or postpartum haemorrhage, recent antibiotics, breastfeeding, breast pain, dysuria, urinary frequency, loin pain, cough, wound pain, abdominal or pelvic pain, offensive lochia, vaginal bleeding, headache, leg pain/swelling, and sick contacts. Examine vitals, mental state, hydration, abdomen for uterine tenderness, lochia, perineal or caesarean wound, breasts for mastitis/abscess, chest, calves, and urinary retention. Initial investigations commonly include CBC, CRP, U&E/creatinine, lactate if septic, blood cultures if systemic illness is suspected, urine dip/culture, wound or lochia cultures when relevant, and imaging guided by the likely source such as pelvic ultrasound for retained products, breast ultrasound for abscess, or chest imaging when respiratory source is suspected.