Overview
Also known as postpartum pyrexia, puerperal pyrexia is defined as a maternal temperature of >38°C within the first 14 days of delivery, most often due to genital or urinary infection.
Causes
Causes of puerperal pyrexia include:
- Endometritis – the most common cause
- Vaginal flora can ascend and infect the upper reproductive tract
- More common in caesarean sections
- Urinary tract infections
- Perineal cellulitis
- Mastitis
- Pneumonia
- Retained placental tissue
- Venous thromboembolism
Risk Factors
Risk factors include:
- Prelabour rupture of membranes
- Procedures (e.g. caesarean delivery, internal foetal monitoring)
- Existing pelvic infections
- Diabetes mellitus
- Obesity
Management
Overview
Management involves hospital admission and intravenous antibiotics (e.g. clindamycin and gentamicin)
Complications
Infection progression and sepsis – can lead to septic shock, multiple organ failure, and death. Necrotising fasciitis is also possible.
Septic pelvic thrombophlebitis – endometritis can cause infections and injuries to adjacent veins, resulting in damage and thrombosis. This can cause persistent puerperal pyrexia that is unresponsive to broad-spectrum antibiotics.
