Which temperature indicates the presence of puerperal infection?
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Immediately after delivery, the woman’s temperature often increases. A temperature of 100.4° F (38° C) or higher during the first 12 hours after delivery could indicate an infection but may not. Nonetheless, in such cases, the woman should be evaluated by her doctor or midwife. A postpartum infection is usually diagnosed after 24 hours
have passed since delivery and the woman has had a temperature of 100.4° F or higher on two occasions at least 6 hours apart. Postpartum infections seldom occur because doctors try to prevent or treat conditions that can lead to infections. However, infections, if they develop, may be serious. Thus, if a woman has a temperature of more than 100.4° F at any time during the first week after delivery, she should call the doctor. Postpartum infections may be CLICK HERE FOR THE PROFESSIONAL VERSION  Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Puerperal pyrexia is defined as the presence of a fever, which is greater than or equal to 38°C, in a woman within six weeks of her having given birth[1]. Even in the 21st century, at least 75,000 women die annually, worldwide of puerperal sepsis, mostly in low-income countries[2]. In the UK, sepsis in the puerperium remains an important cause of maternal death. The mortality rate for pregnancy-related sepsis in the UK was 0.44 deaths per 100,000 maternities in 2015-2017[3]. In the same period indirect maternal deaths from sepsis, (largely due to influenza and pneumococcal infection), were around the same rate. See the separate Maternal Mortality article for more information. The terminology of sepsis has recently changed, and it is important to remain up to date and understand this change[4]. AetiologySpecific causes of puerperal pyrexia may include:
PresentationThe symptoms with which the mother presents may well provide some idea of the source of the infection or there may be many symptoms referring to more than one system, which will require a systematic method of determining the problem. HistoryA full history should be taken, to include a full history of the delivery - establish:
Examination
Investigations
ManagementGeneral measuresIce packs may be helpful for pain from perineal wounds or mastitis. Rest and adequate fluid intake are required, particularly for mothers who are breastfeeding. The following signs and symptoms should prompt urgent referral for hospital assessment and, if the woman appears seriously unwell, by emergency ambulance[1]:
Prophylaxis should be considered for close family members if either Group A streptococcal (GAS) or meningococcus (Neisseria meningitidis) infection is suspected. PharmacologicalAdministration of intravenous broad-spectrum antibiotics within one hour of suspicion of severe sepsis, with or without septic shock, is recommended[1]:
SurgicalSurgical intervention may be required if it is thought that an abscess has formed, as in this case the fever will not settle until the abscess has been incised and drained. ComplicationsThe possible complications of the infection will depend on the site, although several complications such as septicaemia, pulmonary embolus, disseminated intravascular coagulation and pneumonia are common to all. Sepsis with acute organ dysfunction has a mortality rate of 20-40%, rising to around 60% if septicaemic shock develops[10].
PrognosisThe majority of patients will make a full recovery with no lasting effects if treated speedily with appropriate antibiotic therapy and fluids. However, the possibility of septicaemia and lasting sequelae or even death mean it is important to treat all cases of puerperal pyrexia early and aggressively. Prevention
Editor's noteDr Sarah Jarvis, 12th April 2021 New guidance on caesarean birth has been issued by the National Institute for Health and Care Excellence (NICE)[12]. None of the new or updated guidance changes the advice in this leaflet. Which temperature indicates the presence of postpartum infection?A postpartum infection is usually diagnosed after 24 hours have passed since delivery and the woman has had a temperature of 100.4° F or higher on two occasions at least 6 hours apart. Postpartum infections seldom occur because doctors try to prevent or treat conditions that can lead to infections.
What is puerperal fever?puerperal fever, also called childbed fever, infection of some part of the female reproductive organs following childbirth or abortion.
What are the signs and symptoms of postpartum puerperal infection?More severe symptoms specific to a postpartum infection include:. pain below the waist or in the pelvic bone area caused by an inflamed uterus.. pale, clammy skin related to a large amount of blood loss.. foul-smelling vaginal drainage revealing an infection.. increased heart rate from blood loss.. Which is one of the first symptoms of puerperal infection to assess for in the postpartum woman?It is historically referred to as puerperal fever and is divided into early (within 24–48 h) and late (>48 h) postpartum. Fever is often the first sign, with uterine tenderness, bleeding, and foul smelling lochia as additional signs.
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