Browse categories and answer follow-up questions to refine your symptom profile.
History
Context and timing
Postpartum context
Postpartum day since delivery
Delivery type
Vaginal delivery
Cesarean delivery
Prolonged rupture of membranes
Intrapartum fever or chorioamnionitis history
Group B streptococcus status if known
Recent hospital discharge date
Symptom characterization
Primary symptoms
Fever or chills
Pelvic or abdominal pain
Malodorous lochia
Heavy bleeding
Dysuria or flank pain
Breast pain or erythema
Incision pain or drainage
Shortness of breath or pleuritic pain
OPQRST
Onset
Sudden onset
Gradual onset
Provocation and palliation
Worse with uterine palpation
Worse with breastfeeding or milk letdown
Worse with urination
Relief with analgesics
Quality
Cramping
Constant ache
Burning
Sharp pleuritic
Region and radiation
Suprapubic
Lower abdomen
Flank
Breast quadrant
Incision site
Severity
Pain scale
Functional limitation
Timing
Continuous
Intermittent
Cyclical with breastfeeding
Progression over hours to days
Associated symptoms
Associated symptoms
Rigors
Nausea or vomiting
Diarrhea
Headache or photophobia
Myalgias
Rash
Confusion
Syncope
Obstetric and postpartum details
Uterine and bleeding history
Lochia amount trend
Passage of tissue
Uterine tenderness
Breastfeeding history
Lactation status
Cracked nipples
Prior mastitis
Wound and perineal history
Cesarean incision symptoms
Episiotomy or laceration repair symptoms
Prior care and exposures
Prior evaluation and treatment
Recent antibiotics
Recent cultures
Prior imaging
Device and procedure exposures
Indwelling urinary catheter
Intrauterine balloon or instrumentation
Epidural or spinal anesthesia history
Alarm Features
Sepsis and shock triggers
Maternal sepsis concern
Hypotension
Altered mental status
Respiratory distress
Oliguria
Lactate elevation if known
Rapidly worsening pain
Hemorrhage and retained products triggers
Postpartum hemorrhage overlap
Heavy bleeding with clots
Syncope or presyncope
Tachycardia out of proportion
Uterine atony or boggy uterus
Deep infection and necrotizing infection triggers
Deep space infection concern
Severe abdominal pain with guarding
Persistent fever despite antibiotics
Rebound tenderness or rigidity
Necrotizing soft tissue infection concern
Pain out of proportion at incision
Skin discoloration or bullae
Crepitus
Rapid spread over hours
Thromboembolism triggers
Pulmonary embolism concern
Sudden dyspnea
Pleuritic chest pain
Hemoptysis
Unexplained tachycardia
Hypoxemia
CNS infection or preeclampsia overlap triggers
Neurologic red flags
Severe headache with neuro deficit
Seizure
Meningismus
Immediate escalation logic
Escalation triggers
If systolic blood pressure less than 90 mmHg, sepsis bundle and resuscitation bay
If lactate 4 mmol/L or higher, aggressive resuscitation and early vasopressors
If suspected necrotizing infection, immediate surgical consult and broad spectrum antibiotics
Medications
Current and recent medications
Medication reconciliation
Recent antibiotics
Postpartum analgesics
Antihypertensives
Anticoagulants
Immunosuppressants
Allergies and intolerance
Antibiotic risk
Penicillin allergy details
Cephalosporin reaction history
Clindamycin intolerance
Breastfeeding medication considerations
Lactation safety screen
Infant prematurity or jaundice
Avoid tetracyclines prolonged courses when possible
Avoid fluoroquinolones when alternatives available
High risk medication classes
Risk modifiers
Chronic steroids
Biologics
Recent chemotherapy
NSAID overuse with dehydration
Example antibiotic dosing
Empiric antibiotics examples
Clindamycin IV 900 mg every 8 hours
Gentamicin IV 5 mg per kg daily
Ampicillin IV 2 g every 6 hours
Piperacillin tazobactam IV 4.5 g every 6 to 8 hours
Vancomycin IV local protocol dependent dosing by weight and renal function
Diet
Hydration and intake
Intake pattern
Reduced oral intake
Poor fluid intake
Vomiting or diarrhea
Lactation related needs
Breastfeeding related
Increased fluid needs
Missed feeds or engorgement
Exposure and triggers
Exposures
Caffeine and energy drinks
Alcohol exposure
Foodborne illness exposures
Review of Systems
Constitutional and infectious
System screen
Fever
Chills
Night sweats
Fatigue
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Dyspnea
Cough
Orthopnea
Palpitations
Gastrointestinal
Gastrointestinal symptoms
Abdominal pain
Nausea
Vomiting
Diarrhea
Genitourinary and gynecologic
Genitourinary symptoms
Dysuria
Frequency
Flank pain
Gynecologic symptoms
Lochia malodor
Heavy bleeding
Pelvic pain
Vaginal discharge
Breast and skin
Breast and skin
Breast erythema
Breast mass or fluctuance
Nipple trauma
Incision redness
Incision drainage
Neurologic
Neurologic symptoms
Headache
Visual changes
Confusion
Focal weakness
Collateral History and Family History
Collateral and social support
Collateral source
Partner or family report
Home supports and ability to return
Childcare reliability
Household and exposure history
Exposure context
Sick contacts
Recent travel
Community outbreaks
Family history
Heritable risks
Venous thromboembolism history
Thrombophilia history
Early cardiovascular disease
Risk Factors
Obstetric risk factors
Postpartum infection risk
Cesarean delivery
Prolonged labor
Prolonged rupture of membranes
Multiple vaginal exams
Operative vaginal delivery
Postpartum hemorrhage
Retained products history
Host risk factors
Susceptibility factors
Diabetes mellitus (E11.9)
Obesity (E66.9)
Anemia (D64.9)
HIV infection (B20)
Immunosuppression
Device and procedure risk
Iatrogenic risks
Urinary catheter
Uterine instrumentation
Wound hematoma
Thrombosis risk
VTE risk postpartum
Prior VTE
Thrombophilia
Prolonged immobility
Preeclampsia history
Smoking history
Differential Diagnosis
Life threatening
Life threatening causes
Postpartum endometritis with sepsis (O85)
Fever
Uterine tenderness
Foul lochia
Septic pelvic thrombophlebitis
Persistent fever despite antibiotics
Minimal abdominal findings
Pelvic abscess
Fever
Focal pelvic pain
Persistent leukocytosis
Necrotizing soft tissue infection of cesarean wound
Pain out of proportion
Rapid progression
Pulmonary embolism (I26.99)
Sudden dyspnea
Pleuritic pain
Hypoxemia
Pyelonephritis with sepsis (N10)
Flank pain
Costovertebral angle tenderness
Meningitis or encephalitis
Neck stiffness
Altered mental status
Common
Common causes
Postpartum endometritis without shock (O85)
Usually 2 to 10 days postpartum
Polymicrobial risk
Cesarean surgical site infection (O86.0)
Erythema
Drainage
Mastitis (O91.2)
Breast erythema
Systemic symptoms
Urinary tract infection (N39.0)
Dysuria
Positive urinalysis
Pneumonia
Cough
Focal crackles
Less common
Less common causes
Breast abscess
Fluctuant mass
Failure of mastitis therapy
Endometritis due to retained products
Heavy bleeding
Subinvolution
Clostridioides difficile colitis
Recent antibiotics
Watery diarrhea
Ovarian vein thrombosis
Right sided abdominal pain
Fever
Mimics and pitfalls
Mimics and pitfalls
Physiologic postpartum chills
Transient
No persistent fever
Breast engorgement
Bilateral fullness
Improves with milk drainage
Atelectasis or viral syndrome
Mild symptoms
No focal findings
Past Medical History
Relevant conditions
Chronic conditions
Diabetes mellitus
Chronic kidney disease (N18.9)
Chronic liver disease (K76.9)
Valvular heart disease (I38)
Prior infections and colonization
Infection history
Prior MRSA colonization
Recurrent UTIs
Prior postpartum endometritis
Surgical and obstetric history
Procedures
Prior cesarean delivery
Prior uterine surgery
Prior wound complications
Baseline function
Baseline status
Usual vital signs
Baseline anemia history
Functional capacity at home
Physical Exam
Initial appearance and vitals
General and vitals
Toxic appearance
Fever
Tachycardia
Hypotension
Tachypnea
Hypoxemia
Cardiopulmonary
Heart and lungs
New murmur
Rales or focal crackles
Increased work of breathing
Pleuritic pain reproduction absent
Abdomen and pelvis
Abdomen and uterus
Uterine fundal tenderness
Subinvolution
Peritoneal signs
Costovertebral angle tenderness
Pelvic exam if indicated
Cervical motion tenderness
Malodorous discharge
Laceration or hematoma findings
Wound and soft tissue
Incision and perineum
Erythema
Warmth
Fluctuance
Drainage
Dehiscence
Crepitus
Breast exam
Breast findings
Focal erythema wedge
Induration
Fluctuant mass
Nipple fissures
Extremities and VTE exam
VTE findings
Unilateral leg swelling
Calf tenderness
Asymmetry
Neurologic
Neurologic screen
Mental status change
Focal deficits
Nuchal rigidity
Lab Studies
Sepsis and infection labs
Core labs
CBC with differential
Leukocytosis limitations in postpartum period
Neutrophil left shift support
CMP
Renal function for dosing
Hepatic injury pattern
Venous lactate
Repeat within 2 to 4 hours if elevated
Clearance trend as response marker
Blood cultures times 2 before antibiotics if feasible
Do not delay antibiotics in shock
Yield higher with higher fever
Urine testing
Urinary evaluation
Urinalysis
Nitrites and leukocyte esterase
Contamination risk postpartum
Urine culture
Prior antibiotics lower yield
Tailor therapy to susceptibilities
Gynecologic testing
Pelvic infection workup
Vaginal swabs if discharge present
GC and CT testing when risk factors present
Consider placental pathology results if available
Coagulation and anemia
Hemorrhage overlap labs
Hemoglobin trend
Platelets
INR
Fibrinogen local protocol dependent
Breast infection labs
Mastitis and abscess labs
Milk culture for severe or recurrent cases
Wound culture if purulent drainage
Imaging
Scoring Systems
Risk stratification tools
qSOFA
Altered mentation
Respiratory rate 22 per minute or higher
Systolic blood pressure 100 mmHg or less
SIRS
Temperature threshold abnormal
Heart rate 90 per minute or higher
Respiratory rate 20 per minute or higher
WBC abnormal
SOFA or organ dysfunction assessment
Hypotension and vasopressors
PaO2 to FiO2 ratio if available
Creatinine or urine output
Obstetric early warning systems local protocol dependent
Trigger thresholds vary by institution
Use for escalation decisions
MRI
MRI uses
Spinal epidural abscess concern after neuraxial anesthesia
Back pain with fever
Neuro deficit
Deep pelvic soft tissue infection when CT nondiagnostic
Persistent sepsis without source
Pelvic pain with unclear findings
CT
CT indications
Pelvic abscess or deep infection concern
Persistent fever
Peritoneal signs
Ovarian vein thrombosis or septic pelvic thrombophlebitis concern
Persistent fever despite adequate antibiotics
Focal abdominal pain
Pulmonary embolism concern
CT pulmonary angiography if stable and indicated
Contrast considerations postpartum
Contrast safety
Renal function assessment
Lactation counseling local protocol dependent
Ultrasound
Ultrasound indications
Retained products of conception concern
Heavy bleeding
Subinvolution
Persistent endometritis symptoms
Pelvic abscess evaluation
Adnexal tenderness
Focal mass
Breast abscess evaluation
Fluctuant mass
Failure to improve within 24 to 48 hours
DVT evaluation
Compression ultrasound for unilateral leg symptoms
Limited sensitivity for pelvic vein thrombosis
Special Tests
Microbiology and focused diagnostics
Focused diagnostics
Endometrial culture
Rarely required in routine postpartum endometritis
Consider if refractory or unusual pathogens
Wound culture
Purulent drainage
Prior antibiotic failure
Point of care glucose
Sepsis stress hyperglycemia
Diabetes management
Bedside procedures
Procedures
Incision bedside ultrasound for fluid collection
Seroma vs hematoma vs abscess
Guide drainage decisions
Needle aspiration of breast abscess
Diagnostic and therapeutic
Send for culture
Respiratory testing
Respiratory adjuncts
Viral testing when indicated
Chest ultrasound for consolidation when available
ECG
Indications and patterns
ECG indications
Sepsis with tachycardia
Chest pain or dyspnea
Electrolyte abnormalities
High risk findings
New ischemic changes
Atrial fibrillation or flutter
Prolonged QT with electrolyte derangements
Serial ECG logic
Serial monitoring
Repeat ECG with worsening chest symptoms
Repeat ECG after correction of major electrolyte abnormalities
Assessment
Working diagnosis framing
Working diagnosis categories
Postpartum endometritis (O85)
Surgical site infection after cesarean (O86.0)
Mastitis (O91.2)
Urinary tract infection or pyelonephritis
Septic pelvic thrombophlebitis or ovarian vein thrombosis
Pneumonia
Pulmonary embolism (I26.99)
Severity and risk stratification
Severity stratification
Sepsis without shock
Suspected infection plus organ dysfunction
Lactate 2 mmol/L or higher
Septic shock
Vasopressors required for mean arterial pressure 65 mmHg or higher
Lactate 2 mmol/L or higher after fluids
Key complications to exclude
Complications
Pelvic abscess
Retained products
Necrotizing infection
VTE and PE
Clostridioides difficile colitis
Diagnostic uncertainty
Alternate diagnoses
Noninfectious postpartum causes of fever
Drug fever
Viral syndromes
Plan
First 5 minutes
Immediate actions
Monitor
Continuous pulse oximetry
Cardiac monitoring if unstable
IV access
Two large bore IVs if sepsis concern
Intraosseous access if no IV and unstable
Oxygen
Target oxygen saturation 94 percent or higher
Escalate to noninvasive ventilation if increased work of breathing
Sepsis bundle timing
Broad spectrum antibiotics within 1 hour if sepsis or shock
Lactate within 1 hour if unstable
Empiric antibiotics by syndrome
Uterine source suspected
Postpartum endometritis empiric coverage
Clindamycin plus gentamicin
Add ampicillin if enterococcus concern or no improvement
Severe sepsis or polymicrobial concern
Piperacillin tazobactam
Consider vancomycin if MRSA risk
Cesarean wound infection suspected
Cellulitis without purulence
Beta lactam coverage for streptococci and MSSA
MRSA coverage if risk factors
Purulent infection or abscess
MRSA active agent plus gram negative and anaerobe coverage if deep infection concern
Surgical evaluation for drainage
Mastitis suspected
Uncomplicated
Dicloxacillin or cephalexin oral dosing per local protocol
MRSA coverage if high local prevalence or prior MRSA
Severe or systemic toxicity
IV antibiotics and imaging for abscess
Continue breastfeeding or pumping if tolerated
Pyelonephritis suspected
IV antibiotics per local resistance patterns
Tailor to culture results
Source control
Source control strategies
Retained products suspected
Obstetrics consult urgent
Ultrasound correlation
Abscess suspected
Drainage planning
Interventional radiology or surgery involvement
Wound dehiscence or necrotizing concern
Immediate surgical consult
Do not delay debridement for imaging if unstable
Fluids and hemodynamics
Resuscitation targets
Crystalloid bolus 30 mL per kg for hypotension or lactate 4 mmol/L or higher
Vasopressors if hypotension after fluids
Norepinephrine first line
Central access when feasible
Breastfeeding and medication safety
Lactation considerations
Continue breastfeeding or pumping in mastitis unless contraindicated
Avoid breastfeeding interruption unless medication specific
Discuss contrast and antibiotics compatibility local protocol dependent
Reassessment loop
Reassessment schedule
Recheck vitals every 15 to 30 minutes if unstable
Repeat lactate within 2 to 4 hours if elevated
Reexamine uterus and wound after analgesia and antibiotics
Escalate imaging if persistent fever or rising lactate
Consultations
Consultation plan
Obstetrics or gynecology early for uterine or pelvic sources
Surgery for necrotizing infection or severe wound infection
Infectious diseases for refractory sepsis or unusual pathogens
Lactation support for mastitis and breastfeeding continuation
Disposition
ICU and high acuity criteria
ICU criteria
Vasopressor requirement
Persistent lactate elevation despite fluids
Need for invasive ventilation
Altered mental status with sepsis
Inpatient admission criteria
Admission criteria
Postpartum endometritis requiring IV antibiotics
Suspected pelvic abscess
Pyelonephritis with systemic symptoms
Mastitis with systemic toxicity
Wound infection requiring IV therapy or drainage
Observation pathway criteria
Observation considerations
Mild infection with reliable follow up
Improving vitals after initial therapy
No organ dysfunction
Discharge criteria
Discharge criteria
Afebrile or improving trend with stable vitals
Pain controlled with oral medications
No concern for retained products or abscess
Reliable support at home
Clear follow up within 24 to 72 hours
Discharge Instructions
Copy discharge instructions
Summary
You were evaluated for infection after delivery
Your exam and tests today suggest
Medications
Take antibiotics exactly as prescribed until finished
If breastfeeding, continue unless your clinician told you to stop
Do not take extra acetaminophen from multiple products
Activity
Rest and drink fluids
Keep incision clean and dry if you have one
Follow up
Follow up with obstetrics or primary care within 24 to 72 hours
Earlier follow up if symptoms worsen
Return to emergency care now for
Trouble breathing
Chest pain
Fainting
Confusion
Fever that returns or gets worse
Severe abdominal pain
Heavy bleeding or passing large clots
Worsening redness or drainage from incision
New leg swelling or pain
References
Guidelines and key sources
Core references
ACOG guidance on postpartum endometritis and postpartum care
RCOG guideline on bacterial sepsis in pregnancy and postpartum
Surviving Sepsis Campaign guidelines for sepsis and septic shock
WHO recommendations on maternal sepsis recognition and management
IDSA guidance relevant to skin and soft tissue infections and MRSA coverage
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.