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Postpartum complications
Fever after delivery requires a systematic search for the source — uterus, wound, breast, urinary tract, veins — the most common, especially after caesarean section, being infection of the uterine lining (endometritis); at the same time remember the risk of thrombosis, the thyroid and mood.
Why it matters in the exam
Exam questions present a woman a few days after delivery with fever, and ask for the diagnosis and treatment. Endometritis — fever, a tender uterus and foul-smelling lochia — is treated with IV clindamycin and gentamicin until the fever has settled for 24–48 hours. Fever that does not settle despite appropriate antibiotics, with no other source, raises suspicion of septic pelvic thrombophlebitis, which is treated by adding anticoagulation. Mastitis usually appears in the first weeks: a red, painful area of the breast with fever; breastfeeding continues, and antibiotics against staphylococcus are given; an abscess is drained.
Further topics: the postpartum period carries the highest risk of venous thrombosis, so early mobilisation is encouraged and heparin is given to women at risk. Postpartum thyroiditis usually begins with a hyperthyroid phase (1–6 months after delivery) treated with a beta-blocker alone, and moves into a hypothyroid phase. Mood: the baby blues are mild and pass within two weeks, postpartum depression persists and impairs function, and postpartum psychosis is an emergency (see perinatal psychiatry). Postpartum contraception is asked too: no oestrogen in the first three weeks, and the lactational amenorrhoea method (LAM) works only with full breastfeeding, no periods and up to 6 months.
Key points
- Fever after birth: search the fixed places; the most common is endometritis.
- Endometritis: IV clindamycin and gentamicin.
- Fever not responding to antibiotics → septic thrombophlebitis → heparin.
- Mastitis: keep breastfeeding; drain an abscess.
- Postpartum thyroiditis: hyper then hypo; in the hyper phase — beta-blocker alone.
Summary table
| Complication | When and how | Treatment | Exam notes |
|---|---|---|---|
| Endometritis | Days 2–10; fever, tender uterus, foul lochia; mainly after caesarean | IV clindamycin and gentamicin until 24–48 hours without fever | No need to continue oral antibiotics |
| Septic pelvic thrombophlebitis | Fever not responding to antibiotics, no other source | Add heparin | A diagnosis of exclusion |
| Mastitis and abscess | Weeks 1–6; red, painful area, fever | Continue breastfeeding, anti-staphylococcal antibiotics (cephalexin or dicloxacillin); abscess — drainage | Breastfeeding is not dangerous for the baby |
| Venous thrombosis | Highest risk in the first weeks after birth, especially after caesarean | Low-molecular-weight heparin | Warfarin and heparin are compatible with breastfeeding |
| Postpartum thyroiditis | 1–6 months: hyperthyroid then hypothyroid | Hyper phase — beta-blocker; hypo phase — levothyroxine as needed | No antithyroid drugs in the hyper phase |
| Mood | Blues up to two weeks; depression — persists; psychosis — emergency | Blues — support; depression — treatment; psychosis — admission | Screen every woman for depression after birth |
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Sources
- ACOG Committee Opinion No. 736, 2018 — Optimizing Postpartum Care
- ACOG Practice Bulletin No. 196, 2018 — Thromboembolism in Pregnancy
- Academy of Breastfeeding Medicine Clinical Protocol No. 36, 2022 — The Mastitis Spectrum
- Williams Obstetrics, 26th edition (2022) — Puerperal Complications
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.