What is a puerperal infection?
A puerperal infection occurs when bacteria infect the uterus and surrounding areas after a woman gives birth. It’s also known as a postpartum infection.
It’s estimated that 10 percent of pregnancy-related deaths in the United States are caused by infections. Mortality rates are thought to be higher in areas that lack proper sanitation.
There are several types of postpartum infections, including:
- endometritis: an infection of the uterine lining
- myometritis: an infection of the uterine muscle
- parametritis: an infection of the areas around the uterus
What are the symptoms of a puerperal infection?
Symptoms and signs may include:
- pain in the lower abdomen or pelvis caused by a swollen uterus
- foul-smelling vaginal discharge
- pale skin, which can be a sign of large volume blood loss
- feelings of discomfort or illness
- loss of appetite
- increased heart rate
Symptoms may take several days to appear. Sometimes infections may not be noticeable until after you have left the hospital. It’s important to look for signs of an infection even after you have been discharged.
How are puerperal infections caused?
Postpartum infections are less common since the introduction of antiseptics and penicillin. However, skin flora such as Streptococcus or Staphylococcus and other bacteria still cause infections. These thrive in moist and warm environments.
Postpartum infections often start in the uterus after delivery. The uterus can become infected if the amniotic sac becomes infected. The amniotic sac the membranes that contain the fetus.
What are the risk factors?
Your risk for developing an infection after you deliver is different depending on the method used to deliver your baby. Your chance of contracting an infection is:
- 1 to 3 percent in normal vaginal deliveries
- 5 to 15 percent in scheduled cesarean deliveries performed before labor begins
- 15 to 20 percent in non-scheduled cesarean deliveries performed after labor begins
There are additional factors that may make a woman more at risk for developing an infection. These can include:
- bacterial vaginosis, a sexually transmitted infection
- multiple vaginal exams during labor
- monitoring the fetus internally
- prolonged labor
- delay between amniotic sac rupture and delivery
- colonization of the vaginal tract with Group B streptococcus bacteria
- having remains of the placenta in the uterus after delivery
- excessive bleeding after delivery
- young age
- low socioeconomic group
How is puerperal infection diagnosed?
Postpartum infections can be diagnosed by your doctor through a physical exam. Your doctor may take a urine or a blood sample to test for bacteria or use a cotton swab to take a culture of your uterus.
Can puerperal infections cause complications?
Complications are rare. But they can develop if the infection isn’t diagnosed and treated quickly. Possible complications include:
- abscesses, or pockets of pus
- peritonitis, or an inflammation of the abdominal lining
- pelvic thrombophlebitis, or blood clots in the pelvic veins
- pulmonary embolism, a condition in which a blood clot blocks an artery in the lungs.
- sepsis or septic shock, a condition in which bacteria get into the bloodstream and cause dangerous inflammation
How are puerperal infections treated?
Postpartum infections are most commonly treated with oral antibiotics. Your doctor may prescribe clindamycin (Cleocin) or gentamicin (Gentasol). Antibiotics will be tailored to the type of bacteria your doctor suspects caused the infection.
What is the outlook for puerperal infections?
Puerperal sepsis is a potential complication of postpartum infections. It is one of the leading causes of postpartum mortality in the world. Puerperal infections can cause poor health and slow recovery from delivering your baby.
Your likelihood of contracting an infection can be lowered by taking steps to make sure your delivery is sanitary. If you do contract an infection, it is likely that with early medical attention you can be cured.
Can these infections be prevented?
Unsanitary conditions can cause infections. Postpartum infections occur more often in places with unhygienic practices or poor quality healthcare. A lack of awareness amongst healthcare providers or an insufficient sanitation system can lead to higher rates of infection.
The most important risk factor for postpartum infections is type of delivery. If you know that you are going to have a cesarean delivery, you may want to talk to your doctor about what steps the hospital takes to prevent infections. Studies have shown that the following precautions may decrease your chances of contracting a postpartum infection during a cesarean delivery:
- taking an antiseptic shower on the morning of surgery
- removing pubic hair with clippers rather than a razor
- using chlorhexidine-alcohol to prepare the skin
- taking extended-spectrum antibiotics before surgery
Many hospitals already have some of these measures in place to minimize your risk of developing an infection.