Postpartum Infections

Postpartum infections comprise a good range of entities which will occur after vaginal and caesarean delivery or during breastfeeding. In addition to trauma sustained during the birth process or cesarean procedure, physiologic changes during pregnancy contribute to the event of postpartum infections. The standard pain that a lot of women feel within the immediate postpartum period also makes it difficult to discern postpartum infection from postpartum pain.

Postpartum patients are frequently discharged within a few days following delivery. The short period of observation might not afford enough time to exclude evidence of infection before discharge from the hospital.

Causes

Bacteria that normally sleep in the healthy vagina can cause an infection after delivery. Conditions that make a lady more likely to develop an infection include the following:

Ø  A long delay (often more than 18 hours) between rupture of the membranes and delivery

Ø  Internal monitoring of the fetus (which requires rupture of the membranes containing the fetus)

Ø  Prolonged labor

Ø  Cesarean delivery

Ø  Repeated vaginal examinations during labor

Ø  Placental fragments remaining in the uterus after delivery

Ø  Excessive bleeding after delivery (postpartum hemorrhage)

Ø  Anemia

Ø  Bacterial vaginosis

Ø  Young age

Ø  Low socioeconomic group

The chances of developing a uterine infection depend mainly on the sort of delivery:

Ø  Normal vaginal deliveries: 1 to 3%

Ø  Cesarean deliveries that have been scheduled and are done before labor starts: 5 to 15%

Ø  Cesarean deliveries that are not scheduled and are done after labor starts: 15 to 20%

Symptoms

Symptoms of uterine infections commonly include pain within the lower abdomen or pelvis, fever (usually within 1 to three days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. The heart rate is often rapid. The uterus is swollen, tender, and soft. Typically, there's a foul-smelling discharge from the vagina, which varies in amount. The discharge may or may not contain blood. But sometimes the sole symptom may be a low-grade fever.

When the tissues round the uterus are infected, they swell, causing significant discomfort. Women typically have severe pain and a high fever.

Some severe complications can occur but not often. They include the following:

Ø     Inflammation of the membranes that line the abdomen (peritonitis)

Ø     Blood clots in the pelvic veins (pelvic thrombophlebitis)

Ø     A blood clot that travels to the lung and blocks an artery there (pulmonary embolism)

Ø     High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis (a bodywide infection) or septic shock

Ø     A pocket of pus (abscess) in the pelvis

Diagnosis

An infection of the uterus could also be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have had a fever for twenty-four hours after delivery and no other cause is identified.

Usually, doctors take a sample of urine examine, analyze it (urinalysis), and send it to be cultured and checked for bacteria. Urine tests can help identify urinary tract infections.

Other tests are rarely needed but may include culturing a sample of tissue taken from the lining of the uterus and imaging tests, usually computed tomography, of the abdomen.

Treatment

If the uterus is infected, women are usually given antibiotics (usually clindamycin plus gentamicin) intravenously until they need had no fever for a minimum of 48 hours. Afterward, most women do not need to take antibiotics by mouth.

Before a caesarean delivery , doctors may give women antibiotics shortly before surgery. Such treatment can help prevent infections of the uterus and therefore the areas around it.

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