Puerperal infection

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 26, 2016
StartDiseasesPuerperal infection

Pregnancy puts a great deal of stress on the body, and there are many problematic health issues that pregnant women face. Though puerperal fever is no longer very common, it still remains one of the most dangerous aspects of childbirth. The medical term for this condition is a postpartum infection.


Definition & Facts

Puerperal fever happens when the female reproductive system is infected following a pregnancy and delivery. It can be due to many different types of bacteria, but the symptoms generally include a very high grade fever. The infection affects the uterus or vagina.

If the infection is severe enough, puerperal fever can become deadly without medical treatment. Before antibiotics, women frequently died from puerperal fever after a pregnancy. However, modern hygiene methods have greatly reduced the risk of developing a postpartum infection.

Symptoms & Complaints

As the name of the condition implies, the most common symptom of a postpartum infection is a fever. This sort of fever may start out mildly, but it quickly soars to over 100.4 degrees Fahrenheit (38 degrees Celsius).

In addition to the fever, puerperal fever often also results in abdominal pain, foul-smelling vaginal discharge, and chills. Depending on the severity of the condition, a woman may also develop septicemia, cellulitis, and peritonitis.

Cellulitis happens when the infection spreads from the reproductive system to the skin, causing fatigue, swelling, redness, and tenderness in the affected area.

Peritonitis occurs if the puerperal infection travels up into the abdominal wall, causing extreme abdominal pain, nausea, and vomiting.

Septicemia, also called blood poisoning, results in rapid breathing, a fast heart rate (tachycardia), high blood sugar (hyperglycemia), low blood pressure (hypotension), and mental confusion. If left untreated, septicemia can cause deadly shock or organ failure.

Typically, the severity of the puerperal fever and the accompanying medical conditions is related to how aggressive the problematic bacteria is. Because the symptoms of puerperal fever are so varied, a woman may have a postpartum infection while only having one or two of the common symptoms present.


Puerperal fever happens because there are large, bare surfaces in the reproductive system after childbirth. In addition to tears throughout the vaginal canal, there is also a large raw spot along the uterine wall where the placenta separated after delivery.

The process of childbirth can introduce a lot of potentially infectious bacteria into this sensitive area that has several open areas. Once bacteria is introduced to these bare areas of the reproductive tract, it is very easy for it to spread throughout the rest of the body. Additionally, women are normally weakened after childbirth, so it is harder for their immune system to fight against foreign microbes.

The bacteria that cause puerperal fever include streptococcus pyogenes, escherichia coli, staphylococci, and clostridium welchii. These bacteria may exist already in the human body, but these normally harmless bacteria can become problematic after a woman is weakened during childbirth. Even if the problematic bacteria are not already present, they can be introduced to the reproductive tract during examinations, especially if the instruments or the healthcare worker's hands are not cleaned properly.

It is more likely for women to develop these infections if they have a cesarean section or multiple vaginal examinations during childbirth. Certain conditions, including urinary tract infections, endometriosis, and pneumonia all increase a woman's chances of developing a puerperal fever after childbirth. Things that damage immune system functioning, including smoking cigarettes or having an autoimmune disease, also increase a woman's risk of puerperal fever.

Diagnosis & Tests

Because of the unique conditions surrounding postpartum infections, the diagnosis for this condition is generally rather quick. Most doctors are already on the lookout for puerperal fever following a woman giving birth, so they often diagnose it as soon as she starts presenting the classic symptoms of this condition.

In order to diagnose a patient with puerperal fever, the patient must have a temperature of over 100.4 degrees Fahrenheit (38 degrees Celsius) that either lasts 24 hours or occurs repetitively during the first 10 days after childbirth. After the diagnosis of puerperal fever, patients may have a blood test or wound swab taken to create a bacteria culture and identify the specific bacteria causing the infection.

Treatment & Therapy

Until the precise type of bacteria is discovered through a lab test, a patient with puerperal fever will need broad spectrum antibiotics to halt bacterial growth and infection spreading. Any open wounds should be regularly cleaned and kept dry to prevent further spreading. Patients will need to be monitored to make sure that the infection does not worsen or cause septicemia.

If any bits of the placenta or other childbearing remnants are in the uterus still, a patient may need a procedure called curettage. This removes the tissues from the uterus so that they cannot fester and worsen the infection. While the antibiotics are working to stop the puerperal infection, other treatments are often employed to deal with the symptoms.

Cold compresses and other methods of reducing fevers are often very important, and painkillers and anti-nausea (antiemetic) medications may be used to provide relief from the other unpleasant symptoms of puerperal fever.

Prevention & Prophylaxis

Most prevention of puerperal fever relies on good hygiene methods. It is very important for doctors and other childbirth assistants to sterilize their hands before doing any sort of examinations. Any equipment used during childbirth should also be sterilized before use.

Though doctors used to prescribe antibiotics to all pregnant women to prevent puerperal fever, growing concerns about the development of antibiotic-resistant bacteria has led to a decline in this practice. Instead, the progression of puerperal fever is prevented by close monitoring and prompt treatment if a woman's temperatures start to rise.

It is recommended that pregnant women stop smoking and receive treatment for any autoimmune disorders prior to pregnancy to avoid further exacerbating the condition.