Puerperal infection
Puerperal infection is a bacterial condition that arises shortly after childbirth, primarily affecting the birth canal and surrounding areas. Its incidence in the United States varies between 1 to 8 percent among postpartum women, with cesarean deliveries presenting a significantly higher risk. The condition is often caused by bacteria, such as streptococci and Escherichia coli, which can lead to serious complications if not treated promptly. Common symptoms include high fever, abdominal tenderness, and foul-smelling vaginal discharge.
Risk factors for developing puerperal infection include prolonged labor, rupture of membranes, and certain socioeconomic conditions. Diagnosis typically involves assessing symptoms and conducting tests like blood counts and cultures. Treatment usually consists of broad-spectrum antibiotics administered intravenously, with ongoing treatment recommended after symptoms improve. Preventative measures include proper prenatal care, hygiene practices, and possibly prophylactic antibiotics for cesarean patients. Overall, timely intervention results in a favorable prognosis for affected individuals.
Puerperal infection
ANATOMY OR SYSTEM AFFECTED: Reproductive system, uterus
ALSO KNOWN AS: Peurperal fever
Definition
Puerperal infection, a bacterial condition that occurs soon after childbirth, affects the birth canal and surrounding areas. Reported incidence rates in the United States range from 1 to 8 percent of postpartum women. However, the risk is up to ten times higher among women who deliver by cesarean section. The prognosis is good if treatment is initiated in a timely manner. If left untreated, puerperal infection can lead to more serious conditions, such as endometritis (infection of the uterine lining), peritonitis (inflammation of the peritoneum), and pelvic thrombophlebitis (inflammation of the pelvis, which is caused by a blot clot).
Causes
The most common cause of puerperal infection is a bacterial infection in the uterus. Organisms responsible for this infection include streptococci, Escherichia coli, coagulase-negative staphylococci, and Clostridium perfringens. Although such microbes are part of normal vaginal flora, they can trigger infection in the presence of predisposing factors, such as vaginal-membrane rupture, anemia, traumatic labor, or a labor period that is unusually long.
Risk Factors
The risk of contracting an infection changes based on the method used to deliver the baby. Infections occur in 1 percent to 3 percent of standard vaginal deliveries, 5 percent to 15 percent of scheduled cesarean deliveries performed before labor begins, and 15 percent to 20 percent of non-scheduled cesarean deliveries performed after labor begins. Other conditions, such as obesity, diabetes, anemia, and compromised immune systems, may affect a patient's chance of contracting an infection.
Symptoms
Symptoms of puerperal infection include headache, backache, abnormally high body temperature, vaginal discharge, foul-smelling lochia, and pain or tenderness in the abdominal region.
Screening and Diagnosis
The diagnosis is established on the basis of presenting symptoms and on confirmatory testing. Diagnostic assessments include complete blood count, urinalysis, pelvic examination, and cultures of lochia, uterine tissue, and incisional exudates (such as those from an episiotomy or cesarean incision). The white blood cell count is usually very high.
Treatment and Therapy
Broad-spectrum antibiotics, delivered intravenously, are the gold standard of treatment. Commonly used agents are gentamicin and clindamycin. For persistent cases, ampicillin may be added to the regimen. Once the fever has resolved, one should continue antibiotic treatment for an additional forty-eight hours. In cases of thrombophlebitis, heparin can be used to prevent blot clotting.
Prevention and Outcomes
The best way to prevent puerperal infection is to ensure proper prenatal and antenatal care, including personal hygiene and regular obstetric visits. For women who undergo cesarean section, the prophylactic administration of antibiotics may ward off potential infectious bacteria.
Bibliography
Chen, C. L., et al. “Puerperal Infection of Methicillin-Resistant Staphylococcus aureus.” Taiwanese Journal of Obstetrics and Gynecology 47 (2008): 357-359.
Gould, I. M. “Alexander Gordon, Puerperal Sepsis, and Modern Theories of Infection Control: Semmelweis in Perspective.” The Lancet Infectious Diseases 10 (2010): 275-278.
Petersen, Eiko E. Infections in Obstetrics and Gynecology: Textbook and Atlas. New York: Thieme Medical, 2006.
"Puerperal Infections." Healthline, 2 May 2022, www.healthline.com/health/puerperal-infection. Accessed 4 Feb. 2025.