diffuse difficult vaginal childbirth. PPD 7–21: mastitis risk factors include nipple trauma from breastfeeding. Diagnosis Puerperal fever is diagnosed with: A temperature rise above maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10) Oral temperature of or more on any two of the first ten days postpartum. (USJCMW) Puerperal fever (from the Latin puer, male child (boy)), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies: the specific target of infection: endometritis (inflammation of the inner lining of the uterus), metrophlebitis (inflammation of the veins of the uterus), and peritonitis (inflammation of the membrane lining of the abdomen). the severity of the infection: less serious infection (contained multiplication of microbes) or possibly life-threatening sepsis (uncontrolled and uncontained multiplication of microbes throughout the blood stream). Endometritis is a polymicrobial infection. It frequently includes organisms such as Ureaplasma, Streptococcus, Mycoplasma, and Bacteroides, and may also include organisms such as Gardnerella, Chlamydia, Lactobacillus, Escherichia, and Staphylococcus. Differential diagnosis A number of other conditions can cause fevers following delivery including: urinary tract infections, breast engorgement, atelectasis and surgical incisions, among others. Management Antibiotics have been used to prevent and treat these infections—however, the misuse of antibiotics is a serious problem for global health. It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective. Atelectasis: mild to moderate fever, no changes or mild rales on chest auscultation. Management: pulmonary exercises, ambulation (deep breathing and walking). Urinary tract infection: high fever, malaise, costovertebral tenderness, positive urine culture. Management: antibiotics as per culture sensitivity (cephalosporine). Endometritis: moderate fever, exquisite uterine tenderness, minimal abdominal findings. Management: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, addition of ampicillin if no response, no cultures are necessary. Wound infection: persistent spiking fever despite antibiotics, wound erythema or fluctuance, wound drainage. Management: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure. Septic pelvic thrombophlebitis: persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams. Management: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values. Mastitis: unilateral, localized erythema, edema, tenderness. Management: antibiotics for cellulitis, open and drain abscess if present. Epidemiology The number of cases of puerperal sepsis per year shows wide