Feverish Fiona — Postpartum Infection & Mastitis
Fever ≥100.4°F after day 1, foul lochia, or a hot red breast wedge
Fiona is home five days postpartum when chills and a 101.8°F fever hit, and her lochia has turned foul-smelling. Her sister asks if this is normal after having a baby.
Fiona develops a temperature at home a week after a long labor with multiple vaginal exams. Postpartum (puerperal) infection is defined as a fever of 100.4°F or higher on two occasions after the first 24 hours, often from endometritis with foul-smelling lochia and uterine tenderness. Mastitis, usually from a cracked nipple letting bacteria in, causes a hot, red, wedge-shaped area of one breast with flu-like symptoms, and breastfeeding should continue on the affected side to keep the breast drained, not be stopped. Antibiotics, rest, fluids, and frequent emptying of the breast or uterus resolve most cases before they progress to sepsis.
Read Feverish Fiona's full story →The story arc
The setup
Fiona's labor was long with several vaginal exams and an eventual vaginal delivery, and a cracked nipple developed during early breastfeeding attempts.
The turn
At home, she notices her lochia smells foul and her uterus feels tender when she presses on it.
The crisis
Her temperature spikes to 101.8°F with chills, and days later a hot, red, wedge-shaped area appears on her left breast along with body aches.
The save
Fiona's provider starts antibiotics for endometritis, and for the mastitis she is taught to keep breastfeeding on the affected side, apply warm compresses, and empty the breast fully with each feeding.
NCLEX study section — Postpartum Infection & Mastitis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.