Puerperal pyrexia, also known as puerperal fever is a rise of temperature (fever) reaching 100.4° F or more within the first 10 days after delivery.
Puerperal fever due to infection is the leading cause of maternal death, if not treated in time. Puerperal pyrexia and sepsis are among the leading causes of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. Most postpartum infections take place after hospital discharge, which is usually 24 hours after delivery.
Causes
There are various causes of fever during the postpartum period, infection is the most common cause, notably puerperal sepsis, which is ranked by the World Health Organization as the 6th leading cause of disease burden for women aged 15–44 years. Other causes of puerperal pyrexia may include
- Postpartum infections (genital tract infections)
- Perineal wound infection
- Urinary tract infections such as cystitis (Inflammation of the urinary bladder) and pyelonephritis (Inflammation of the kidney due to infection)
- Endometritis
- Puerperal sepsis
- Breast infections may include mastitis and breast abscess
- Cesarean Section wound abscess
- Leg venous thrombosis
- Nasocomial infections are acquired in hospitals or other health facilities and may come from the hospital environment or from the patient’s own flora.
- Medical problems such as malaria, pulmonary tuberculosis, respiratory infection, and other causes of fever
Prophylaxis reduces endometritis by 66-75% and also reduces rate of wound infection.
Risk factors
The risk factors leading to the development of fever due to sepsis include home birth in unhygienic conditions, low socioeconomic status, poor nutrition, primiparity, anemia, prolonged rupture of membranes, prolonged labor, multiple vaginal examinations in labor, cesarean section, obstetrical maneuvers, retained bits of tissues within the uterus and postpartum hemorrhage.
Symptoms
Symptoms usually depend on the underlying problem and the nature of the infection.
- Mild to moderate fever
- The feeling of discomfort or illness
- Body pain
- Chills
- Headache
- Loss of appetite
- Lower abdomen pain
- Foul-smelling vaginal discharge or wound drainage
Consult your health care provider immediately if you experience any of the above symptoms after delivery. Your healthcare provider may do certain tests to find the underlying problem and start treatment.
Diagnosis
Your health care provider may do a physical examination. Vaginal swabs are taken to detect the bacteria responsible for causing the infection, and a pelvic exam is performed to determine the extent and cause of the infection. Other tests include
- Blood samples are taken for culture and complete blood count
- Urinalysis is done to detect the organism responsible for urinary tract infection
- Wound culture
- X-rays
- Ultrasound to detect retained products of conception
Treatment
Medical treatment may includes
After confirming the diagnosis, your health care provider may prescribe broad-spectrum antibiotics to control the infection. Antibiotics are given by IV route for 48 hours for the rapid desired effect. Analgesics and antipyretics are given to relieve pain and fever.
General measures may include
- Adequate bed rest and sleep
- Frequent perineal and episiotomy care
- To relieve pain, apply an ice pack for the first 24 hours after vaginal delivery followed by a sitz bath.
- Have a balanced diet for the baby to have a good milk supply and prevent infections
- Daily wound care and dressing
Surgical procedures may include
Surgery may be required to remove the products of conception or to drain any abscess as in the case of abscess formation, incision, and drainage is performed. In the case of an infected episiotomy wound, it is opened and drained, followed by re-stitching.
Prevention
The risk of prenatal infection and pyrexia can be reduced if you follow certain preventive measures.
- Keep wound area clean and dry
- Infection during pregnancy should be treated
- Anemia and other conditions that may reduce female resistance are used to treat
- Traumatic delivery should be avoided
- Antiseptic and aseptic measures to be followed while performing any procedure
- Infected cases are isolated
- Prophylactic antibiotics are given to women who’ve had traumatic delivery or prolonged labor.
Conclusion
In this post, we have discussed puerperal pyrexia. Puerperal fever is defined as the presence of fever greater than 100.4° F within the first 10 days after delivery. Pyrexia is usually caused by infection. Rise in temperature, feeling of discomfort, headache, and abdominal pain are some of the symptoms that can be diagnosed by doing a pelvic exam and blood tests. It is usually treated with antibiotics, antipyretics, and surgical procedures.
