Puerperal fever
IG: Sio Cheong Un
2011/4/4
Puerperal fever
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Puerperal fever, also known as postpartum fever or
puerperal infection
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Definition: temperatures in the postpartum fever
reach 100.4F(38.0C) or higher. The fevers occur on any
two of the first 10 days postpartum, exclusive of the
first 24 hours.
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Abortion or miscarriage isn’t usually associated with
this infection and fever.
Benign fever following vaginal
delivery
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Benign single-day fevers:
Fever in the first 24 hours after delivery often
resolves spontaneously and cannot be explained
by an identifiable infection.
Benign fever following vaginal
delivery
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One retrospective cohort study of 2137 vaginal
deliveries in 1996. Patients were randomly
selected from the 25,687 vaginal deliveries that
took place between 1979 and 1992 at The
University of Iowa Hospitals and Clinics. The
data were analyzed using odds ratios and
multiple logistic regression.
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CONCLUSIONS : Single-day fever was more
likely to occur in primiparous women and in
women who were monitored with a uterine
pressure catheter. Most women with benign
single-day fevers had early low-grade fevers,
whereas women with endometritis had higher
fevers that occurred later in the postpartum
period.
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Fever is not an automatic indicator of puerperal
infection. A new mother may have a fever owing
to prior illness or an illness unconnected to
childbirth. However, any fever within 10 days
postpartum is aggressively investigated. Physical
symptoms such as pain, malaise, loss of appetite,
and others point to infection.
Puerperal fever
Causes ( listed in order of decreasing frequency )
include endometritis (most common), urinary
tract infection, pneumonia\atlectasis, wound
infection, and septic pelvic thrombophlebitis.
Septic risk factors for each etiologic condition
are listed in order of the postpartum day(PPD)
on which the condition generally occurs.
risk increases with
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❑ prolonged and premature rupture of the membranes
❑ prolonged (more than 24 hours) labor
❑ frequent or unsanitary vaginal examinations or unsanitary
delivery
❑ retained products of conception
❑ hemorrhage
❑ maternal conditions, such as anemia, poor nutrition during
pregnancy.
❑ cesarean birth (20-fold increase in risk for puerperal infection).
❑ genital or urinary tract infection prior to delivery.
❑ use of a fetal scalp electrode during labor.
❑ obesity.
❑ diabetes.
❑ urinary catheter
❑ nipple trauma from breastfeeding
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The associated symptoms depend on the site
and nature of the infection. The most typical site
of infection is the genital tract. Endometritis,
which affects the uterus, is the most prominent
of these infections. Endometritis is much more
common if a small part of the placenta has been
retained in the uterus.
Physical examination
A pelvic examination is done and samples are
taken from the genital tract to identify the
bacteria involved in the infection. The pelvic
examination can reveal the extent of infection
and possibly the cause.
Laboratory
Blood samples may also be taken for blood
counts , CRP, or blood culture.
A urinalysis may also be ordered, especially if the
symptoms are indicative of a urinary tract
infection.
Chest x-ray
Wound culture
Treatment
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Treatment of puerperal infection usually begins with
I.V. infusion of broadspectrum antibiotics and is
continued for 48 hours after fever is resolved.
Supportive care
Symptomatic treatment
Surgery may be necessary to remove any remaining
products of conception or to drain local lesions, such as
An infected episiotomy (incision made during delivery)
may need to be opened and drained.
In the presence of thrombophlebitis, heparin therapy
will be needed to provide anticoagulation.
CASE
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A 28-year-old primigravid underwent a cesarean
section secondary to having a breech
presentation and rupture of membranes at 36
weeks gestation. The cesarean section was
uncomplicated, but on postpartum day two the
patient was having fever (38.5C) and uterine
tenderness.
A diagnosis of postpartum endometritis was
made and the infection was treated with
Mefoxine 1 g IV Q8H.
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After 24 hours of antibiotics, the patient
presented pain in the right lower abdomen and
loin, and her WBC count was 12000/mm3. She
continued to spike fevers .
Abd:soft,flat, tenderness on the right
abdomen,no rebound-tenderness, Mcburney’s
point (+/-),Murphy’s sign(-), kindey region
percussion (-).
Urinalysis was unremarkable.
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On postpartum day four, the patient’s condition
was no improvement after antibiotic treatment,
and an abdominal CT scan was obtained. A right
ovarian vein thrombosis was noted on the
imaging.
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IMP: ovarian vein thrombophlebitis
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The patient started therapeutic
enoxaparin(clexane). After 48 hours of
anticoagulation, the patient was afebrile and
asymptomatic. The patient was discharged home
after being anticoagulated with warfarin and
after 6 weeks a CT scan was repeated. The right
ovarian thrombosis was not present in the
images and warfarin was discontinued
Prevention
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Avoid the risk factors
Keep the episiotomy site clean
Careful attention to antiseptic procedures during
childbirth is the basic underpinning of
preventing infection. With some procedures,
such as cesarean section, a doctor may
administer prophylactic antibiotics as a
preemptive strike against infectious bacteria.
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