Postpartum endometritis

How recovery typically progresses

Immediately after

First days

During the first 48 hours after birth, fever, chills, worsening lower-abdominal pain, uterine tenderness, or foul-smelling lochia needs immediate contact with the maternity team. Normal afterpains should not cause fever or a progressively ill feeling. Cesarean birth and prolonged rupture of membranes raise risk but are not required.

Settling in

Early weeks

From day 3 through the first few weeks, postpartum endometritis may appear after discharge. Do not wait for a scheduled postpartum visit if fever reaches 100.4°F (38°C), discharge smells bad, pain worsens, or flu-like illness develops. The clinician will also consider urinary, breast, wound, and other infection sources.

Longer arc

Beyond six weeks

Endometritis can present as late as six weeks after birth. Persistent or returning fever, uterine or pelvic pain, foul discharge, or feeling acutely unwell still warrants prompt assessment even if recovery had been going well. Confusion, trouble breathing, faintness, or rapidly worsening illness requires emergency care.

What does the evidence show for postpartum endometritis?

• ACOG describes postpartum endometritis as usually appearing 2 to 10 days after birth, although it can occur through 6 weeks. Fever, chills, feeling ill or tired, abdominal tenderness, and foul-smelling vaginal discharge warrant an immediate call to the obstetric clinician because the infection can progress to sepsis. 1
• Postpartum endometritis is primarily a clinical determination based on postpartum fever with uterine tenderness, lower-abdominal pain, purulent or foul lochia, or delayed uterine involution. Blood tests and cultures can support assessment but a negative result does not by itself exclude the condition; urinary, breast, wound, lung, and clot-related causes may mimic it. 2
• A Cochrane review of 42 randomized trials involving 4,240 participants found fewer clinical failures with clindamycin plus an aminoglycoside than with some other antibiotic regimens. The trials were heterogeneous and mostly older, so regimen choice still depends on allergies, local practice, severity, and whether another infection source is present. 3
• In a retrospective case-control study of 1,605 low-transverse cesarean births, 124 met the study definition for endometritis. Younger age and anemia or blood transfusion were independently associated, while duration of ruptured membranes was marginally associated. The single-center cesarean-only design does not estimate risk after vaginal birth. 4
• A hospital cohort of 428 patients assessed for puerperal fever identified endometritis in 233. Within that selected group, ultrasound evidence of retained products, fever during the first 14 days, abdominal pain, and foul lochia were associated with uterine evacuation, but this study cannot provide population incidence or make ultrasound a stand-alone test. 5

When should I call my provider about postpartum endometritis?

Call the obstetric clinician immediately for postpartum fever of 100.4°F (38°C) or higher, chills, worsening uterine or lower-abdominal tenderness, foul-smelling discharge, or feeling acutely ill. Go to emergency care for confusion, fainting, trouble breathing, severe abdominal pain, heavy bleeding, very fast worsening, or concern for sepsis. State clearly that you recently gave birth. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.