Focus physical examination on identifying the source of fever and infection. A complete physical examination is necessary, including pelvic and breast examinations. Some women have foul-smelling lochia without other evidence of infection. Some infections, most notably caused by group A beta-hemolytic streptococci, frequently are associated with scanty, odorless lochia. Patients with wound infection, or episiotomy infections, have erythema, edema, tenderness, and discharge from the wound or episiotomy.
Infection is frequently unilateral.
Patients with pyelonephritis, or urinary tract infections, may present with costovertebral angle tenderness and elevated temperature. Respiratory signs, such as rales, consolidation, or rhonchi in pneumonia, are possible. Patients with septic pelvic thrombosis, although rare, may have palpable pelvic veins. These patients also have tachycardia out of proportion to their fever. In most cases of endometritis, the bacteria responsible for pelvic infections are those that normally reside in the bowel, vagina, perineum, and cervix.