Puerperal fever: causes, symptoms, and treatment of postpartum infection
Postpartum infection—commonly known as puerperal fever—is one of the complications that can occur after childbirth. Knowing what signs to look out for and when to act can make all the difference. Here's what every new mom should know before her baby arrives.
Fever after childbirth: causes are not always the same
Fever during the postpartum period can have several causes. One of the most common is mastitis, an inflammation of breast tissue caused by milk stagnation when the baby doesn't completely empty the breast. It leads to pain, a sensation of warmth, swelling, and an elevated temperature. Cold compresses, frequent feedings in different positions, and ibuprofen usually relieve these symptoms. If symptoms do not improve after a day or two, consult a doctor.
A more serious cause is puerperal infection: postpartum wounds are colonized by bacteria, leading to an infection of the uterus and surrounding tissues.
What is puerperal fever?
Puerperal fever is an infection of postpartum wounds—in the vagina, perineum, or cesarean incision—and the uterine lining. In more severe cases, it can spread to the urinary tract or become a systemic infection affecting the entire body. Complications can include parametritis, salpingitis, or, in severe cases, pelvic peritonitis. Along with late postpartum hemorrhage, thrombosis, and fecal constipation, it is one of the four most common postpartum complications.
Causes
Puerperal fever is most often caused by aerobic bacteria—including E. coli, streptococci, and Staphylococcus aureus—and, more rarely, by anaerobic strains. It usually results from the combined action of several bacterial strains. Bacterial colonization of the genital tract does not always lead to
infection; the immune system usually manages to counteract it. However, certain risk factors significantly increase this risk:
- Perineal tears, episiotomy wounds, or cesarean incisions
- Significant blood loss weakening the immune system
- Obstetrical interventions during childbirth
- Bacteria transmitted by medical personnel
Symptoms
- Vaginal discharge accompanied by an unpleasant odor, with consistency changing as the infection progresses
- High fever, often exceeding 39 °C
- Uterine contraction problems, which can lead to hemorrhage
- Swelling, pain, and redness around the wound
- Acute abdominal pain to the touch, which may be accompanied by nausea, vomiting, increased heart rate, and shallow breathing
If left untreated, puerperal infection can progress to hypovolemic shock and become life-threatening.
Treatment
A puerperal infection requires immediate hospitalization—outpatient treatment is not indicated. Standard treatment relies on broad-spectrum antibiotics, ideally guided by an antibiogram, as several bacterial strains are usually involved. Pain relief medication is also prescribed in addition to antibiotic therapy. The earlier treatment is initiated, the lower the risk of the infection becoming systemic.
⚠️ If you develop a fever during the postpartum period accompanied by any of the above symptoms, contact your doctor or go to the hospital immediately. Do not wait.