Puerperal infection is an infection (after the first 24 hours) following delivery of a baby. It can affect the vagina, vulva, perineum (area between the vagina and rectum), cervix, uterus, and peritoneum (membrane that covers abdominal organs) or kidneys. The infection is caused by bacteria that are normally found in a healthy vagina, but are more likely to multiply and cause infection if one or more risk factors are present. 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, a long delay between rupture of the placental membranes and delivery (greater than 24 hours), prolonged labor, traumatic delivery, repeated vaginal examinations with non-sterile equipment during labor, retained fragments of placenta in the uterus, and excessive bleeding after delivery.
Symptoms may include:
Unexplained fever and chills for 2 or more days after the first postpartum day (first day after delivery)
Headache and muscle aches
Appetite loss
Rapid heartbeat
Soft, large, and tender uterus
Vaginal discharge with abdominal pain
What your doctor can do:
Diagnose the infection by asking about your symptoms, doing a physical exam, laboratory blood studies, blood cultures, and cultures of the vaginal discharge
Hospitalize you for intensive treatment and possible surgery to remove any retained fragments of the placenta
Prescribe antibiotics in high doses. These may be given intravenously (IV)
Prescribe anticoagulants if necessary to prevent blood-clot formation
Prescribe pain medicine and acetaminophen (Tylenol) to reduce fever and pain
What you can do:
Take steps to prevent infection by avoiding exposure to anyone with an active infection during the last 2 weeks of pregnancy
Notify your doctor as soon as your placental membranes rupture (your "water breaks"). Do not have sexual intercourse after membranes rupture. Wash the perineal area several times a day during the first week after delivery
To help relieve pain, place a moist heating pad or hot-water bottle on your abdomen or back. Take frequent hot showers to relax muscles and relieve pain
Use sanitary pads rather than tampons for the vaginal discharge
If you plan to breast-feed, talk to your doctor about the possibility of using a breast pump to express milk until the infection is gone
Get help in caring for your newborn. The more you are able to rest and care for yourself, the sooner you will be healthy again
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
Drink lots of fluids to prevent dehydration
Vitamin and mineral supplements should not be necessary unless you are anemic
What you can expect:
With early diagnosis and appropriate treatment and care, the infection should be controlled within a short time.
Possible complications include a deep-vein blood clot in the pelvis, blood poisoning, shock, and infection in the newborn infant.
Contact your doctor if you have any vaginal discharge with a foul odor, chills or fever over 100.4 F, heavier bleeding than a normal period, severe pain or cramping, a skin rash, are feeling faint, or possible symptoms of a bladder infection (increased frequency of urination, urgency, or pain while urinating).
