Postpartum Infections
Key Points
- Postpartum infections include wound infection, postpartum-endometritis, urinary tract infection, mastitis, and nipple/breast thrush.
- Fever at or above 38 C (100.4 F), tachycardia, worsening pain, foul lochia, or purulent drainage require immediate reassessment and escalation.
- Prevention priorities are hand hygiene, perineal care, pelvic rest, rest/nutrition support, and early treatment of localized infection before progression to sepsis.
- Early sepsis screening reduces maternal morbidity and mortality in postpartum infection pathways.
Pathophysiology
Postpartum infection risk rises when tissue trauma, retained blood/fluid, disrupted skin or mucosal barriers, and invasive procedures allow microbial entry and growth. Prolonged rupture of membranes, chorioamnionitis, urinary catheter exposure, operative birth, and severe lacerations increase infectious burden during recovery.
Infection can remain localized (perineal wound, uterine lining, bladder, breast tissue) or progress systemically. As host response intensifies, inflammatory and hemodynamic changes may lead to maternal sepsis, organ hypoperfusion, and higher mortality risk if recognition and treatment are delayed.
Classification
- Wound infections: Perineal, episiotomy, laceration, or cesarean-incision infection with redness, pain, drainage, and fever.
- Uterine infection: postpartum-endometritis with uterine tenderness, foul-smelling lochia, increased bleeding, and fever.
- Urinary infection: Cystitis or ascending infection after retention/catheter exposure; postpartum UTI occurs in about 2 to 4 percent of births.
- Breast infections: mastitis from milk stasis or nipple trauma and nipple-thrush from yeast overgrowth.
Nursing Assessment
NCLEX Focus
Priority questions test whether the nurse distinguishes normal postpartum discomfort from worsening infection and sepsis progression.
- Trend temperature, heart rate, respiratory rate, and overall clinical appearance each shift and with symptom changes.
- Assess wound and perineum using structured findings such as reeda-scale elements (redness, edema, ecchymosis, discharge, approximation).
- Evaluate lochia odor/amount, fundal tenderness, urinary symptoms, flank pain, and bladder-emptying pattern.
- Assess breasts and latch quality for nipple trauma, localized warmth/erythema, and flu-like symptoms.
- Screen for early sepsis indicators: fever or hypothermia, tachycardia, tachypnea, abnormal WBC trend, altered mentation, hypotension, and reduced urine output.
Nursing Interventions
- Start ordered anti-infective therapy promptly, monitor response, and reinforce full-course adherence after discharge.
- Teach hand hygiene, peri-care, wound care, pad changes, hydration, sleep support, and pelvic rest (no intercourse, tampons, or douching) during healing.
- Promote infection-specific comfort care (pain control, breast emptying support, compresses, and rest) while preserving breastfeeding when safe.
- Escalate rapidly for signs of worsening infection, pyelonephritis, abscess progression, or sepsis deterioration.
- Provide discharge teaching on return precautions: worsening pain, increasing fever, foul discharge, heavy bleeding, dysuria, flank pain, or purulent wound drainage.
Sepsis Risk
Postpartum infections contribute substantially to maternal morbidity and mortality (about 5 to 10 percent); delayed escalation can rapidly progress to life-threatening sepsis.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| penicillin-antibiotics | Ampicillin context | Monitor symptom response and adverse effects; reinforce completion of therapy. |
| aminoglycosides | Gentamicin context | Monitor renal/ototoxicity risk and follow CBC/culture trends with severe infection pathways. |
| antipyretics | Acetaminophen context | Supports comfort and fever reduction while definitive infection treatment continues. |
Clinical Judgment Application
Clinical Scenario
A postpartum patient on day 2 reports severe uterine tenderness, foul-smelling lochia, fever of 38.3 C (100.9 F), tachycardia, and profound fatigue.
Recognize Cues: Fever above threshold, uterine pain, malodorous lochia, and systemic symptoms suggest active infection. Analyze Cues: Pattern is most consistent with endometrial infection and possible early sepsis trajectory. Prioritize Hypotheses: Immediate priorities are infection control, hemodynamic stability, and prevention of systemic deterioration. Generate Solutions: Notify provider, obtain ordered cultures/labs, start antibiotics/antipyretics, and intensify vital-sign and urine-output monitoring. Take Action: Implement treatment bundle and reassess response after interventions. Evaluate Outcomes: Temperature and heart rate improve, pain decreases, and no new sepsis signs develop.
Related Concepts
- nursing-care-during-the-postpartum-period - Routine postpartum surveillance is the foundation for early infection detection.
- physiologic-changes-during-the-postpartum-period - Differentiates expected recovery findings from pathologic infection signs.
- postpartum-hemorrhage - Infection and hemorrhage can coexist and compound maternal deterioration risk.
- mastitis - Common postpartum breast infection requiring latch and breast-emptying support.
- maternal-sepsis - High-risk progression pathway requiring urgent recognition and escalation.
Self-Check
- Which findings distinguish likely postpartum endometritis from normal postpartum discomfort?
- Why does catheter exposure or urinary retention increase postpartum UTI risk?
- Which sepsis cues in a postpartum patient should trigger immediate provider escalation?