Postpartum Infections 

  • Author: Andy W Wong, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 14, 2010
 

Background

Postpartum infections comprise a wide range of entities that can occur after vaginal and cesarean delivery or during breastfeeding. In addition to trauma sustained during the birth process or cesarean procedure, physiologic changes during pregnancy contribute to the development of postpartum infections.[1] The typical pain that many women feel in the immediate postpartum period also makes it difficult to discern postpartum infection from postpartum pain.

Postpartum patients are frequently discharged within a couple days following delivery. The short period of observation may not afford enough time to exclude evidence of infection prior to discharge from the hospital. In one study, 94% of postpartum infection cases were diagnosed after discharge from the hospital.[2] Postpartum fever is defined as a temperature greater than 38.0°C on any 2 of the first 10 days following delivery exclusive of the first 24 hours.[3] The presence of postpartum fever is generally accepted among clinicians as a sign of infection that must be determined and managed.

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Pathophysiology

Local spread of colonized bacteria is the most common etiology for postpartum infection following vaginal delivery. Endometritis is the most common infection in the postpartum period. Other postpartum infections include (1) postsurgical wound infections, (2) perineal cellulitis, (3) mastitis, (4) respiratory complications from anesthesia, (5) retained products of conception, (6) urinary tract infections (UTIs), and (7) septic pelvic phlebitis. Wound infection is more common with cesarean delivery.

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Epidemiology

Frequency

United States

Overall US rates for incidence and prevalence of postpartum infections is lacking. In a study by Yokoe et al in 2001, 5.5% of vaginal deliveries and 7.4% of cesarean deliveries resulted in a postpartum infection.[2] The overall postpartum infection rate was 6.0%. Endometritis accounted for nearly half of the infections in patients following cesarean delivery (3.4% of cesarean deliveries). Mastitis and urinary tract infections together accounted for 5% of vaginal deliveries.[2]

Mortality/Morbidity

In most reviews, maternal death rates associated with infection range from 4-8%, or approximately 0.6 maternal deaths per 100,000 live births.

A pregnancy-related mortality surveillance by the Centers for Disease Control and Prevention indicated infection accounted for about 11.6% of all deaths following pregnancy that resulted in a live birth, stillbirth, or ectopic.[4]

Race

The risk of postpartum urinary tract infection is increased in the African American, Native American, and Hispanic populations.[5]

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Contributor Information and Disclosures
Author

Andy W Wong, MD  Resident Physician, Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital

Andy W Wong, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Assaad J Sayah, MD  Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Cunningham G, Levano KJ, Gilstrap LC, et al. Williams Obstetrics. 22nd ed. McGraw-Hill; 2005.

  2. Yokoe DS, Christiansen CL, Johnson R, Sandu KE, et al. Epidemiology of and Surveillance for Postpartum Infectious. Emerg Infect Dis. Sep-Oct 2001;7(5):837-41. [Medline].

  3. Adair FL. The American Committee of Maternal Welfare, Inc: The Chairman's Address. Am J Obstet Gynecol. 1935;30:868.

  4. Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. Feb 21 2003;52(2):1-8. [Medline].

  5. Schwartz MA, Wang CC, Eckert LO, Critchlow CW. Risk factors for urinary tract infection in the postpartum period. Am J Obstet Gynecol. Sep 1999;181(3):547-53. [Medline].

  6. Monif GR, Baker DA. Infectious Diseases in Obstetrics and Gynecology. 6th ed. Informa HealthCare; 2008.

  7. Atterbury JL, Groome LJ, Baker SL, Ross EL, Hoff C. Hospital readmission for postpartum endometritis. J Matern Fetal Med. Sep-Oct 1998;7(5):250-4. [Medline].

  8. Newton ER, Prihoda TJ, Gibbs RS. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet Gynecol. Mar 1990;75(3 Pt 1):402-6. [Medline].

  9. Maharaj D. Puerperal Pyrexia: a review. Part II. Obstet Gynecol Surv. Jun 2007;62(6):400-6. [Medline].

  10. Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol. 2006;2006:15614. [Medline].

  11. Chaim W, Burstein E. Postpartum infection treatments: a review. Expert Opin Pharmacother. Aug 2003;4(8):1297-313. [Medline].

  12. French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. Oct 2004;18(4):CD001067. [Medline].

  13. [Guideline] American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. Sep 2001;108(3):776-89. [Medline].

  14. Kaiser J, McPherson V, Kaufman L, Huber T. Clinical inquiries. Which UTI therapies are safe and effective during breastfeeding?. J Fam Pract. Mar 2007;56(3):225-8. [Medline].

  15. Wagenlehner FM, Weidner W, Naber KG. An update on uncomplicated urinary tract infections in women. Curr Opin Urol. Jul 2009;19(4):368-74. [Medline].

  16. Cipro package insert. West Have, Conn. Bayer Pharmaceuticals Corporation. April 2009.

  17. Grady R. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J. Dec 2003;22(12):1128-32. [Medline].

  18. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003;26(13):925-35. [Medline].

  19. Cohen J, Powderly W. Episiotomy infections and postabortion sepsis. In: Infectious Diseases. 2nd ed. 2004:697-698.

  20. Del Priore G, Jackson-Stone M, Shim EK, Garfinkel J, Eichmann MA, Frederiksen MC. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis. Obstet Gynecol. Jun 1996;87(6):994-1000. [Medline].

  21. French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. 2002;CD001067. [Medline].

  22. Gabbe, SG. Puerperal endometritis, serious sequelae of puerperal infection. In: Obstetrics: Normal and Problem Pregnancies. 4th ed. 2002:1304-1308.

  23. Gilstrap LC, Faro S. Postpartum endometritis. In: Infections in Pregnancy. 2nd ed. 1997:65-78.

  24. Monga M, Oshiro BT. Puerperal infections. Semin Perinatol. Dec 1993;17(6):426-31. [Medline].

  25. Sweet RL, Gibbs RS. Postpartum infection. In: Infectious Diseases of the Female Genital Tract. 3rd ed. 1995:578-600.

 
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