Which of the following is not a typical symptom of puerperal infection?

• A. Fever
• B. Uterine tenderness
• C. Severe headache not accompanied by fever
• D. Foul lochia

Answer: (C)

Puerperal infection (such as endometritis) typically causes an inflammatory response after birth, so fever is a key sign, along with uterine tenderness and foul-smelling lochia. A severe headache without fever does not reflect an infectious process in the uterus postpartum. Postpartum headaches have other possible causes—migraine, dehydration, spinal or epidural anesthesia–related headaches, or preeclampsia/eclampsia if accompanied by high blood pressure and other symptoms. So the presence of a severe headache without fever isn’t part of the usual infection picture. If fever is present with headache, then infection should be considered, but the headache alone without fever isn’t typical of puerperal infection.