Post Partum Infections (Puerperal Sepsis)

Last updated 20.09.12

 

 

Definition

-  Infection which develops after child birth, typically 2 to 10 days later during puerperium

-  Puerperal sepsis = fever >38o within 14 days of delivery

 

Features

-  Various presentations

-  Can occur after vaginal or LUSCS delivery

-  Vaginal incidence 5.5%

-  LUSCS incidence 7.4%

-  Typically develops post D/C from hospital

-  Previously a major cause of maternal mortality (prior to Abx)

 

Cause

-  Endometritis >50% (PID)

-  Wound infection (LUSCS or perineal repair)

-  Typically evident 3-4 days post op

-  More common in obesity & obstructed/prolonged labour

-  Perineal cellulitis

-  Mastitis

-  RPOC

-  UTI

-  Post anaesthetic pneumonia or atelectasis

-  Esp GA

-  Septic pelvic phlebitis

-  Common Organisms

-  Staph + Strep

-  Opportunistic bowel or vaginal flora

 

Risk Factors

-  Prolonged ROM

-  Antenatal infection

-  FSE

-  Frequent vaginal exams in labour (esp once membranes ruptured)

-  Anaemia

-  LUSCS

-  GDM or DM

-  Obesity

-  Low socioeconomic status

 

Associated S/S

-  Chills, fever

-  Foul smelling lochia, abdominal pain: endometritis

-  PV bleeding: RPOC

-  Secondary PPH

-  Wound discharge +/- cellulitis: wound infection

-  Tender, inflamed breasts: mastitis

-  Flank pain, dysuria: UTI

 

DDx

-  Appendicitis

-  VTE: DVT, PE

 

Ix

-  Vitals

-  Temp: fever: infection

-  HR, BP: sepsis

-  FBE, CRP: inflammation

-  U&E

-  +/- BC

-  HVS swabs MCS

-  +/- wound swab

-  Urine Dipstick + MCS

-  +/- US

-  Pelvic US: exclude RPOC, abscess & infected haematoma

-  Breast US: breast abscess (mastitis)

 

Mx

-  Mx of sepsis as indicated

-  As per presentation cause

-  Endometritis as per PID (non sexually acquired)

-  Mastitis

-  UTI

-  Wound infection

-  +/- drainage

-  Usually heal by secondary intention

 

 

 

References

 

Emedicine.medscape.com/article/796892-overview#a0101