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Background: Puerperal pyrexia is generally accepted among clinicians as a sign of infection that must be determined and managed to prevent adverse sequelae associated with underlying cause. Objective: The objective of this study was to determine the incidence, pattern, predisposing factors and aetiologic agents of puerperal pyrexia at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Southeast, Nigeria. Materials and Methods: This was a prospective descriptive study of all cases of women that had puerperal pyrexia at Alex Ekwueme Federal University Teaching Hospital, Abakaliki over a 4-year period. The statistical analysis was done using SPSS version 22. Results: During the study period, there were 203 cases of puerperal pyrexia and 12,902 deliveries. The incidence of puerperal pyrexia was 15.7 cases per 1000 deliveries. Most of the women 82(40.4%) were aged between 27- 32 years, grandmultipara (43.8%) and unbooked (69.5%). Common risk factors included prolonged rupture of membranes (78.3%), prolonged labour (71.9%) and caesarean section (55.7%). Surgical wound infection was the commonest cause(39.9%) of puerperal pyrexia. The commonest complication of puerperal infection is septicaemia (43.4%). Maternal death attributable to postpartum infection was 3.9%. Conclusion: Puerperal pyrexia is a preventable and treatable condition, however, timely recognition and early treatment of underlying cause is important in other to avert maternal morbidity and mortality associated with it. Adoption of universal aseptic technique in the care of patients will reduce the incidence of wound infection.