Pharmacology of Obstetrics
Postpartum pyrexia is fever ≥38°C on any two of the first ten days postpartum, excluding the first 24 hours. It can signal mild or life-threatening conditions.
Etiology: 5 Ws
- Wind: Pulmonary (atelectasis)
- Water: UTI
- Wound: Incision/episiotomy
- Walking: DVT/thrombophlebitis
- Wonder drugs: Mastitis/drug reaction
Timing & Features
| Timing | Causes | Features |
|---|---|---|
| Day 1 | Physiological | Mild, resolves |
| 1–2 | Pulmonary | Dyspnea |
| 2–5 | UTI | Dysuria |
| 3–7 | Wound/endometritis | Pain, foul lochia |
| 5–10 | DVT | Leg swelling |
Endometritis most common
Risk Factors
- Cesarean (highest)
- Prolonged labor, PROM
- Instrumental delivery
- Anemia, diabetes
Diagnosis
- History: onset, symptoms
- Exam: vitals, wound, breast, legs
- Labs: CBC, CRP, cultures
- Imaging: ultrasound, Doppler
Management
- Supportive: hydration, analgesia
- Endometritis: clindamycin + gentamicin
- UTI: cephalosporins
- Mastitis: flucloxacillin
- DVT: LMWH
Prevention
- Asepsis
- Prophylactic Abx for C-section
- Early ambulation
- Minimize exams
Key Takeaways
- ≥38°C on 2/10 days
- 5 Ws mnemonic
- Endometritis most common
- Risk: cesarean, PROM
- Targeted Abx
- Prevent with asepsis
Conclusion
Postpartum fever demands systematic investigation. Use 5 Ws for diagnosis.
Postpartum pyrexia is a signal — decode it fast.