PUERPERAL INFECTION

General Information

DEFINITION--Infection of the birth canal after the first 24 hours following delivery of a baby.

BODY PARTS INVOLVED--Any or all: vagina; vulva; perineum (area between the vagina and rectum); cervix, uterus; peritoneum (membrane that covers abdominal organs).

SEX OR AGE MOST AFFECTED--Females of childbearing age.

SIGNS & SYMPTOMS

• Unexplained fever and chills for 2 or more days after the first postpartum day (first day after delivery).
• Headache.
• Muscle aches.
• Appetite loss.
• Rapid heartbeat.
• Soft, large, tender uterus.
• Vaginal discharge with an unpleasant odor.
• Abdominal pain.

CAUSES--Infection by bacteria normally found in a healthy vagina. These bacteria can infect the uterus, vagina, adjacent tissues and kidney, especially in conjunction with risk factors.

RISK INCREASES WITH

• Insertion of a fetal scalp electrode during labor.
• Anemia, either pre-existing or from loss of blood during delivery.
• Toxemia during pregnancy.
• Long delay between rupture of the placental membranes and delivery (greater than 24 hours).
• Prolonged labor.
• Traumatic delivery.
• Repeated vaginal examinations with unsterile equipment during labor.
• Retained fragments of placenta in the uterus.
• Excessive bleeding after delivery.

HOW TO PREVENT

• Avoid anyone with an active infection for the last 2 weeks of pregnancy.
• Notify your doctor as soon as placental membranes rupture (your "water breaks"). Don't have sexual intercourse after membranes rupture.
• Wash the perineal area often during the first week after delivery.
• Ask your prenatal care doctor for a culture for group D strep at 28-34 weeks of pregnancy for screening purposes.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and physical exam by a doctor.
• Laboratory blood studies, blood culture and culture of the vaginal discharge.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Hospitalization for intensive treatment.
• Surgery to remove fragments of placenta (sometimes).

POSSIBLE COMPLICATIONS

• Deep-vein blood clot in the pelvis.
• Blood poisoning.
• Shock.

PROBABLE OUTCOME--Usually curable in 7 to 10 days with intensive treatment. Without treatment, complications can be severe and sometimes fatal.

How To Treat

GENERAL MEASURES--

• To relieve pain, place a heating pad or hot-water bottle on the abdomen or back.
• Take frequent hot baths to relax muscles and relieve pain.
• Use sanitary pads rather than tampons for the vaginal discharge.
• If you plan to breast-feed, use a breast pump to express milk until the infection heals.

MEDICATION--Your doctor may prescribe:

• Antibiotics in high doses--intravenously, if necessary.
• Codeine and acetaminophen to reduce fever and pain.
• Anticoagulants to prevent blood-clot formation.

ACTIVITY--

• Rest in bed, except to use the bathroom, until fever and other signs of infection subside. You will probably be more comfortable if you lie on your left side.
• Abstain from sexual relations until signs of infection have been gone at least 7 days.

DIET--Drink lots of fluids to prevent dehydration from high fever. Vitamin and mineral supplements should not be necessary unless you are anemic.

Call Your Doctor If

• You have symptoms of a puerperal infection even several hours after delivery.
• You faint.
• You develop a skin rash.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
• Symptoms of infection recur after treatment.