Postpartum infections | |
---|---|
Other names | Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections |
![]() | |
Streptococcus pyogenes (red-stained spheres) is responsible for many cases of severe puerperal fever. | |
Specialty | Obstetrics |
Symptoms | Fever, lower abdominal pain, bad-smelling vaginal discharge[1] |
Causes | Typically multiple types of bacteria[1] |
Risk factors | Cesarean section, premature rupture of membranes, prolonged labour, malnutrition, diabetes[1][2] |
Treatment | Antibiotics[1] |
Frequency | 11.8 million[3] |
Deaths | 17,900[4] |
Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage.[1] 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.[1] It usually occurs after the first 24 hours and within the first ten days following delivery.[5]
The most common infection is that of the uterus and surrounding tissues known as puerperal sepsis, postpartum metritis, or postpartum endometritis.[1][6] Risk factors include caesarean section (C-section), the presence of certain bacteria such as group B streptococcus in the vagina, premature rupture of membranes, multiple vaginal exams, manual removal of the placenta, and prolonged labour among others.[1][2] Most infections involve a number of types of bacteria.[1] Diagnosis is rarely helped by culturing of the vagina or blood.[1] In those who do not improve, medical imaging may be required.[1] Other causes of fever following delivery include breast engorgement, urinary tract infections, infections of an abdominal incision or an episiotomy, and atelectasis.[1][2]
Due to the risks following caesarean section, it is recommended that all women receive a preventive dose of antibiotics such as ampicillin around the time of surgery.[1] Treatment of established infections is with antibiotics, with most people improving in two to three days.[1] In those with mild disease, oral antibiotics may be used; otherwise intravenous antibiotics are recommended.[1] Common antibiotics include a combination of ampicillin and gentamicin following vaginal delivery or clindamycin and gentamicin in those who have had a C-section.[1] In those who are not improving with appropriate treatment, other complications such as an abscess should be considered.[1]
In 2015, about 11.8 million maternal infections occurred.[3] In the developed world about 1% to 2% develop uterine infections following vaginal delivery.[1] This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[1] In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[4][7] They are the cause of about 10% of deaths around the time of pregnancy.[2] The first known descriptions of the condition date back to at least the 5th century BCE in the writings of Hippocrates.[8] These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[9] In 1847, Hungarian physician Ignaz Semmelweiss decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of handwashing with calcium hypochlorite.[10][11]
© MMXXIII Rich X Search. We shall prevail. All rights reserved. Rich X Search