Endometritis is the most common source of postpartum infection. The history and course of the delivery is very important in evaluating postpartum patients. Ascertain if delivery was vaginal or by cesarean section. Ascertain if premature rupturing of membranes occurred. Assess patient's symptoms.
Patient complaints vary depending on the source of infection.
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.