A puerperal infection occurs when bacteria infect the uterus and surrounding areas after a female gives birth. It’s also known as a postpartum infection.

In 2018, the Centers for Disease Control and Prevention (CDC) estimated that, for every 10,000 live births in the United States, 17.3 females died from pregnancy-related complications.

For the same year, the CDC linked the highest death rates to heart and blood circulation problems. However, the second highest cause of pregnancy-related death was postpartum infections at 13.9%.

Death rates were also higher in populations that may have a harder time accessing healthcare, such as people in rural areas and non-Hispanic Black people. Females with heart disease, diabetes, and high blood pressure also had higher death rates.

Read on to learn more about what can cause puerperal infections and how to treat them.

Postpartum infections are described by the three distinct areas where they may occur, including:

  • Endometritis: uterine lining
  • Myometritis: uterine muscle
  • Parametritis (also called pelvic cellulitis): supporting tissue around the uterus

The most frequent postpartum infection is endometritis since the lining of the uterus can undergo trauma and tears during the birthing process. This damage provides an entrance for infection to develop.

Infection in the uterus muscle or the structures supporting the uterus may form at the incision or tear sites, such as in an episiotomy or a cesarean delivery (C-section).

General signs of a postpartum infection are like a typical infection, such as:

More severe symptoms specific to a postpartum infection include:

  • pain below the waist or in the pelvic bone area caused by an inflamed uterus
  • pale, clammy skin related to a large amount of blood loss
  • foul-smelling vaginal drainage revealing an infection
  • increased heart rate from blood loss

Symptoms may take several days to appear. Sometimes infections may not be noticeable until after you have left the hospital. It is important to look for signs of infection even after you have been discharged.

An intact uterus is considered sterile. However, bacteria that live on the skin, such as Streptococcus or Staphylococcus, and other bacteria can still cause infections by invading damaged skin or tissue. These bacteria thrive in the moist and warm environment of the lower abdomen.

Postpartum infections can start in the uterus after the mother’s water breaks. Additionally, the uterus can become infected if the amniotic sac and its fluid become infected. The amniotic sac is the membrane that contains the fetus and fluids.

Your risk of developing an infection after you deliver differs depending on the method used to deliver your baby. Your chance of contracting an infection is:

  • 1-3% of standard vaginal deliveries
  • 5-15% of scheduled cesarean deliveries performed before labor begins
  • 15-20% of non-scheduled cesarean deliveries performed after labor begins

An added risk may include females with no previous pregnancy and extremes in age, such as very young or older.

Furthermore, prior medical conditions such as obesity, diabetes, high blood pressure, anemia, and immune system problems may add to the chance of infection.

Additional factors may make a female more at risk for developing an infection. These can include:

  • multiple vaginal exams during labor
  • monitoring the fetus inside the uterus
  • delay between amniotic sac rupture and delivery or prolonged labor
  • manual removal of the placenta
  • having remains of the placenta in the uterus after delivery
  • excessive bleeding after delivery
  • baby’s stool found in amniotic fluid
  • use of a catheter to soften the opening of the uterus for birth

Other infectious conditions that may contribute to postpartum infections, namely:

Your doctor can diagnose postpartum infections primarily through a physical exam. The doctor will review your risk factors and check for fever over 100.4°F (38°C), pain, bleeding, and foul-smelling vaginal discharge.

If needed, the doctor may check a white blood cell count to see if your body is fighting an infection. Your doctor will then move quickly to diagnose an infection to decrease the chance it will enter your bloodstream.

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 blood clot that blocks an artery in the lungs.
  • septic shock, bacteria get into the bloodstream and cause dangerously low blood pressure

Postpartum infections are primarily treated with broad-spectrum antibiotics given intravenously (IV) if you are still in the hospital. Broad-spectrum antibiotics cover a variety of bacteria and are used when the type of bacteria is unknown.

If you have symptoms of an infection after you return home, the doctor may readmit you to the hospital for treatment. Once your condition is under control with IV antibiotics, the doctor will likely switch to an oral antibiotic upon discharge.

Oral antibiotics may include:

Postpartum infection is the second leading cause of maternal death in the U.S. and can cause poor health and slow recovery after delivering your baby. The chance of dying from an infection that reaches the blood is close to 20%, and if septic shock happens, the death rate is approximately 40%.

Recognizing infection symptoms and getting treatment immediately decreases your risk to 2%.

The most critical risk factor for postpartum infections is the type of delivery.

The American College of Obstetricians and Gynecologists suggests certain precautions may decrease your chances of contracting a postpartum infection during cesarean delivery:

  • removing pubic hair with clippers rather than a razor
  • taking a shower with chlorhexidine soap at least the night before surgery
  • keeping blood sugar under 200 mg/dL throughout pregnancy

Your doctor may use the following prevention practices before surgery:

  • preparing the incision area with an alcohol-based preparation
  • administration of a one-dose antibiotic 1 hour before incision
  • administration of an entire course of antibiotics for GBS or bacterial vaginosis

If you know you will have a cesarean delivery, you may want to talk with your doctor about steps to prevent infections.

Here are answers to additional questions about puerperal infection.

What is puerperal infection?

A puerperal infection, also known as postpartum infection, is an infection of the uterus and surrounding tissues. This usually happens after the trauma of vaginal birth or cesarian delivery.

What does a puerperal infection feel like?

A puerperal infection may feel like you have the flu, chills, aches, and loss of appetite. You may also have tenderness or sharp pain in the belly area.

Who is at risk for puerperal infection?

The most significant risk for puerperal infections is cesarean delivery. Likewise, females with diabetes, high blood pressure, obesity, anemia, and immune system problems are more prone to infections.

Reduce your risk of postpartum infection by understanding your risks, knowing the signs of infection, and closely following your doctor’s instructions.

Some postpartum infections happen out of your control despite the best planning and doctor care.

Knowing and discussing your risk factors with your doctor during pregnancy checkups will improve decision-making and your comfort with medical advice.

After you leave the hospital with your baby in your arms, understand and watch for infection signs such as fever, chills, aches, and loss of appetite in combination with abdomen tenderness. Seek immediate attention from your doctor if you experience these symptoms.