Another common cause of pain and fever in the puerperium is a urinary tract infection (UTI). A woman with a UTI complains of urine coming too frequently, a burning sensation when she passes urine, and the urge to urinate very often. When you gently press on her abdomen overlying the pelvis she will have pain. This woman needs referral for treatment with antibiotics.

UTI is common during pregnancy and the puerperium because of:

• urinary retention due to urinary tract obstruction in some women in late pregnancy;
• manipulation and trauma to the urethra during labour and delivery, which increases the risk of bacteria from the birth canal and rectum ascending into the bladder and from there to the kidneys.