Puerperal fever
| Postpartum infections | |
|---|---|
| Synonyms | puerperal fever, childbed fever |
| (red-stained spheres) is responsible for many cases of severe puerperal fever. (900x magnification) | |
| Classification and external resources | |
| Specialty | obstetrics |
| ICD-10 | O85 |
| ICD-9-CM | 672 |
| eMedicine | article/796892 |
| MeSH | D011645 |
Postpartum infections, also known as puerperal infections, is any bacterial infection of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge. It usually occurs after the first 24 hours and within the first ten days following delivery.
The most common infection is that of the uterus and surrounding tissues known as puerperal sepsis or postpartum metritis. Risk factors include Cesarean section, the presence of certain bacteria such as in the vagina, premature rupture of membranes, multiple vaginal exams, manual removal of the placenta, and prolonged labour among others. Most infections involved a number of types of bacteria. Diagnosis is rarely helped by culturing of the vagina or blood. In those who do not improve, medical imaging may be required. Other causes of fever following delivery include: breast engorgement, urinary tract infections, infections of the abdominal incision or episiotomy, and atelectasis.
Due to the risks following C-section, it is recommended that all women receive a preventive dose of antibiotics such as ampicillin around the time of surgery. Treatment of established infections is with antibiotics, with most people improving in two to three days. In those with mild disease, oral antibiotics may be used; otherwise intravenous antibiotics are recommended. Common antibiotics include a combination of ampicillin and gentamicin following vaginal delivery or clindamycin and gentamicin in those who have had a C-section. In those who are not improving with appropriate treatment, other complications such an abscess should be considered.
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