Puerperal fever is a serious condition resulting from infection of the uterus during childbirth characterized by acute fever, which occurs in women within 24 to 72 hours of childbirth. Such infections often cause pain in the lower abdomen, fever, and smelly discharge. They are more common after a cesarean delivery, especially if it was not planned. Management is based on the administration of broad-spectrum antibiotics.

The adjective puerperal comes from the Latin “puer”, which means “child”, and from “parere”, which means “to show oneself”. Thus “puerperium” corresponds to the period following birth, after childbirth, previously called “period of childbirth”. Today, this period refers to the postnatal or postpartum period.

Puerperal fever, also called childbirth fever or childbirth fever, is a medical term that was widely used to designate a mysterious disease that struck women after childbirth. It is actually a serious condition resulting from an infection of the uterus, called “endometritis”, at the time of childbirth, characterized by an acute fever that occurs in women usually on the second or third day. after childbirth, sometimes even just a few hours after childbirth.

Puerperium fever, once a major cause of death in women, has become rare in developed countries thanks to better monitoring of patients following childbirth.

Upper genital infections are rather rare over a lifetime. Indeed, the antibacterial properties of the endometrium, the closure of the cervix and the acidity of vaginal secretions constitute a bulwark against the occurrence of genital infections. However, these protective barriers are weakened during childbirth and during the postpartum period. The vulnerability of the organism of the childbirth then favors the installation and the development of pathogenic microorganisms. This damage to the uterus is the starting point for puerperal fever.

The puerperal fever actually has four main causes:

• endometritis or infection of the uterus;
• utero-pelvic or lower limb phlebitis;
• urinary tract infection, favored by the insertion of a urinary catheter during childbirth;
• breast infection (engorgement, breast abscess, lymphangitis).

The infection tends to be polymicrobial and the causative pathogens are usually streptococcus or staphylococcus.

The predisposing factors for puerperal endometritis, which is the main cause of puerperal fever, are:

• a long interval (often more than 18 hours) between rupture of membranes and childbirth;
• internal monitoring of the fetus which requires rupture of the membranes that contain the fetus;
• prolonged work;
• a cesarean delivery;
• regular vaginal exams during labor;
• retention of placental fragments in the uterus after childbirth;
• excessive bleeding after childbirth (postpartum hemorrhage);
• bacterial colonization of the lower genital tract;
• anemia;
• bacterial vaginitis;
• a young maternal age;
• belonging to a disadvantaged socio-economic group.

The chances of developing a uterine infection also depend on the type of childbirth:

• normal vaginal deliveries: 1 to 3%;
• deliveries by cesarean section scheduled in advance and performed before the onset of labor: 5 to 15%;
• unscheduled cesarean deliveries performed after the onset of labor: 15 to 20%.

Symptoms of uterine infections commonly include:

• pain in the lower abdomen or pelvis, with uterine spasms;
• fever ;
• pallor;
• chills ;
• a general feeling of being unwell or uncomfortable;
• headaches;
• loss of appetite;
• tachycardia, that is, an acceleration of the heartbeat;
• smelly vaginal secretions of varying abundance, with or without the presence of blood.

Sometimes, however, the only symptom is a low fever.

Some serious complications can occur:

• inflammation of the membranes around the abdomen (peritonitis);
• blood clots in the pelvic veins (pelvic thrombophlebitis);
• a clot traveling to the lungs and blocking in an artery (pulmonary embolism);
• high levels of toxins in the blood, produced by infectious bacteria, leading to sepsis, which is infection of the whole body, or septic shock;
• a pelvic abscess that may present as a distinct, palpable mass adjacent to the uterus.

With sepsis and septic shock, the blood pressure drops excessively and the heart rate is greatly increased. This can cause serious kidney damage or even death. These complications are rare, especially when postpartum fever is diagnosed and promptly treated.

Administration of intravenous antibiotics

In case of uterine infection, the patient is given intravenous antibiotic treatment, usually clindamycin plus gentamicin, for at least 48 hours after the fever has fallen. Most of the time, it is not necessary to continue taking oral antibiotics.

Prevention

When delivery is by cesarean section, prophylactic antibiotics given within 60 minutes before the procedure can reduce the risk of endometritis by up to 75%.