Postpartum Infections

Postpartum Infections - Bug Invasion Basics

• Definition: Puerperal sepsis (postpartum infection): Fever >38°C on any 2 of the first 10 days postpartum, excluding the first 24 hours.
• Major Types:
  • Endometritis (most common)
  • Wound infections (perineal, C-section)
  • Urinary Tract Infections (UTI)
  • Mastitis
• Common Causative Organisms (Often Polymicrobial):
  • Group A & B Streptococcus (GAS, GBS)
  • Staphylococcus aureus
  • Escherichia coli (E. coli)
  • Anaerobes (e.g., Bacteroides, Peptostreptococcus)
• General Risk Factors:
  • Prolonged Rupture of Membranes (PROM >18h)
  • Multiple vaginal examinations (≥6)
  • Caesarean section (emergency > elective)
  • Retained products of conception
  • Maternal anemia, poor hygiene, diabetes

⭐ Most common cause of postpartum fever is endometritis.

Endometritis - Uterine Under Siege

Most common postpartum infection, an inflammation of the uterine lining (endometrium).

• Key Features: High fever (>38°C), chills, marked uterine tenderness, foul-smelling lochia, uterine subinvolution.
• Diagnosis: Primarily clinical. Endometrial culture if unresponsive to initial empiric antibiotics.
• Treatment:
  • Prompt broad-spectrum IV antibiotics.

  ⭐ Clindamycin + Gentamicin is the gold standard IV antibiotic regimen for postpartum endometritis.

  • Add Ampicillin for Group B Strep (GBS) coverage if severe or septic.
• Complications: Parametritis, peritonitis, pelvic abscess, septic pelvic thrombophlebitis (SPT).

Wound Infections - Suture Site Sepsis

Affects C-section incisions or episiotomy/perineal tears.

• Risk Factors: Obesity, diabetes, emergency C-section, chorioamnionitis, poor hygiene.
• Clinical:
  • Local: Pain, erythema, warmth, swelling, purulent discharge.
  • Systemic: Fever.
  • 📌 REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation) for assessment.
• Organisms: Staph aureus (most common), Strep spp., E. coli.
• Management:
  • Wound care: Opening, drainage, debridement.
  • Antibiotics: Oral for mild; IV for severe/cellulitis (consider MRSA coverage).
• Prevention: Aseptic surgical technique, prophylactic antibiotics for C-section.

⭐ Prophylactic antibiotics given before C-section skin incision significantly reduce wound infection rates.

Mastitis & UTI - Ducts & Drains Drama

• Mastitis: Typically 2nd-3rd week postpartum.
  • Symptoms: Unilateral breast pain, tenderness, erythema, warmth, fever, flu-like symptoms.
  • Organism: Staph aureus (most common).
  • Risk Factors: Milk stasis, cracked nipples.
  • Management: Continue breastfeeding/pumping, NSAIDs, warm compresses, antibiotics (Dicloxacillin/Cephalexin).
  • Complication: Breast abscess.
• UTI: Cystitis or pyelonephritis.
  • Risk Factors: Catheterization, birth trauma.
  • Symptoms: Dysuria, frequency, urgency (cystitis); flank pain, fever (pyelonephritis).
  • Organism: E. coli.
  • Management: Antibiotics - Nitrofurantoin for cystitis, IV Ceftriaxone for pyelonephritis.

⭐ For infective mastitis, continued breastfeeding from the affected breast is recommended.

Septic Pelvic Thrombophlebitis - Vein Villainy

• Rare, serious: infected thrombus in ovarian/pelvic veins.
• Key sign: Persistent high fever despite 48-72h antibiotics for endometritis; pelvic pain.
• Diagnosis: Exclusion; CT/MRI confirms.
• Treatment:
  • Anticoagulation (Heparin).
  • Broad-spectrum IV antibiotics.

⭐ Persistent fever unresponsive to 48-72 hours of appropriate antibiotics for endometritis strongly suggests Septic Pelvic Thrombophlebitis.

High‑Yield Points - ⚡ Biggest Takeaways

• Endometritis is the most common postpartum infection; typically polymicrobial.
• Risk factors: Cesarean section, prolonged ROM, multiple vaginal exams.
• Symptoms: Postpartum fever (>38°C), uterine tenderness, foul-smelling lochia.
• Diagnosis is clinical; blood cultures for severe or unresponsive cases.
• Treatment: Broad-spectrum IV antibiotics (e.g., Clindamycin + Gentamicin).
• Septic pelvic thrombophlebitis: Persistent fever despite adequate antibiotics.
• Mastitis: Focal breast tenderness, fever; usually Staphylococcus aureus.