Signs, Etymology, Types, and Treatment

Updated

04 September 2020

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Published

07 December 2018

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Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK

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After a few days or weeks of giving birth, your body can experience some sort of frustrating symptoms. Having the perfect understanding of this kind of symptoms and what they can cause will help prevent it and you will experience them no more.

What are postpartum infections?

Postpartum infections can be observed in various parts of the body – boggy uterus, breast – and you must watch for them.

Whenever you observe any discomfort or an unbearable pain in your body, your first line of action is getting to your doctor.

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Common types of postpartum infections

There are various signs of infection after birth and symptoms in the body after giving birth that pertains to specific infections in the body.

There are different types of postnatal infections which affects mothers and they can affect the uterus, abdomen and other parts.

The common types of postpartum infections are the following:

Endometritis

Endometritis is defined as an infection of the upper genital tract including endometrium, myometrium, and surrounding tissue.

A 2012 Cochrane review of endometritis found a 1–3% rate of endometritis after vaginal delivery and 5–10 times higher rates following caesarean section. 

Endometritis risk factors include:

• Prolonged rupture of membranes (>18 h)
• Colonization with group A or B streptococcus
• Chorioamnionitis
• Prolonged operative time
• Bacterial vaginosis
• Internal monitoring
• Multiple vaginal exams.

Endometritis is a potentially severe postpartum infection that most likely will require hospitalization.

Puerperal mastitis

Puerperal mastitis is a regional infection of the breast, commonly caused by the patient’s skin flora or the oral flora of breastfeeding infants. The organisms enter an erosion or cracked nipple and proliferate, leading to infection. Lactating women will often have bilaterally warm, diffusely tender, and firm breasts, particularly at the time of engorgement or milk letdown.

Mastitis can be treated with oral antibiotics (e.g. dicloxacillin).

In addition, patients should be encouraged to breastfeed, which prevents intraductal accumulation of infected material. Those who are not breastfeeding should breast pump in the acute phase of the infection.

Women who are unresponsive to oral antibiotics are admitted for IV(intravenous) antibiotics until afebrile for 48 hours. If there is no response to IV antibiotics, a breast abscess should be suspected and an imaging study obtained.  

Urinary tract infection

This is a puerperal infection that affects women that undergo delivery through both the cesarean section and vagina.

This type of infection is associated with a series of discomfort, and having a long term hospitalization.

This type of infection has been found to lead to a stoppage in breastfeeding.

The women that are affected by this type of infection must have had “asymptomatic antepartum bacteriuria” which follows the trauma of delivery. This type of infection is usually not different from the uterus infection (endometritis) when observed in the body clinically.

This infection can be treated using postpartum infection antibiotics. When you feel disturbed, you should visit your physician to prevent continuous pain and discomfort.

Wound infection

This is an infection that occurs after a C-section.

The incision area in the woman’s body can be infected by the presence of bacteria around these areas. This infection can be recognized by various symptoms such as redness(erythema) of the incision site, fever, lower abdominal pain after giving birth, etc.

Oral antibiotics with coverage against streptococci, staphylococci, enteric, and anaerobic organisms are first line in treating perineal infections.

Perineal infection

This type of infection affects the perineum and ranges from mild to complicated in women with health-related issues.

Perineal infection should be properly taken care of especially in women with health issues such as diabetes, hypertension, etc. Women should go for postnatal treatments when they observe any form of discomfort in the perineum region. A timely visit to your healthcare provider will help with checkup and diagnosis.

Other forms of postpartum infections are as follows:

• Pudendal and paracervical block infection
• Abdominal wound infection
• Intravenous infection
• Soft tissue infection, etc.

Causes of postpartum infections

After delivery, the woman body is prone to postnatal infections which are caused by bacteria and other microorganisms. Infections can be caused by staphylococcus, a bacterial usually present in the oral cavity of the baby or within the abdominal and uterus lining of the mother. 

Signs of postpartum infections

Postpartum infections take various forms in the mother’s body. These infections can be expressed as abscesses in the breast, chills, fever, swelling of the body or abdominal pain after giving birth.

There may also be an inflammation of the urethra lining, and other parts of the body. There could also be some sort of itching around the vagina coupled with other disturbing symptoms in the vagina. 

The most common signs of postpartum infections are:

• Too much bleeding or hemorrhage discharge from the vagina.
• Foul smell coming out from the vagina.
• Little or no bleeding after delivery is a potential problem as well
• Increment or swelling of the uterus
• Pain in one or both of your breasts.
• Frequent nausea and/or vomiting.
• Hot or tender legs.
• Having breathing problems
• Having flu-like symptoms.
• High fever 
• Problem when urinating, extremely dark urine.
• Severe headaches.

Steps to take if you think you have postpartum infection

Now, if you have been having any sort of complications in your body, the best way to overcome this is by visiting your doctor.

Your physician will help you determine if you do have or do not have such infection and will decide on the appropriate postpartum infection treatment if you have such an infection. Your first point of call should be with your healthcare provider. Your physician is at the right position to diagnose you and if he can’t, he will give you guidance in how to go about it.

No worries, most postpartum infections can be treated with the use of antibiotics and can be easily done by yourself. However, postpartum infections shouldn’t be taken lightly, and you must seek medical attention.

History of updates

Current version
(04 September 2020)

Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK

Published
(07 December 2018)

Everything You Need to Know

Written by WebMD Editorial Contributors

In this Article

• Recovering from Giving Birth
• What Is Postpartum Endometritis?
• Symptoms and Signs of Postpartum Endometritis
• Who Gets Postpartum Endometritis?
• Diagnosis and Treatment for Postpartum Endometritis

Giving birth is an amazing experience for many women. After your baby is born, it’s normal to focus all your attention and efforts on your little one. But it’s just as important to remember to take care of yourself. Giving birth isn’t easy, and your body needs plenty of time to recover.

Recovering from birth takes time. Many women start to feel like themselves in about 6 to 8 weeks, but it could take a few months. As your body adjusts, it’s normal to feel some aches and pains.

During your recovery period, your hormones can fluctuate, and you could experience mood shifts, temporary hair loss, and increased sweating at night. You may also experience constipation, water retention, and weight loss.

Some of the more uncomfortable changes you may experience are:

• Perineum soreness
• Hemorrhoids
• Abdominal pain
• Vaginal bleeding or discharge
• Sore nipples and breasts

While discomfort after giving birth is normal, certain pains or symptoms related to postpartum endometritis aren’t. So, what is postpartum endometritis, and how can it be treated?

Postpartum endometritis is an infection that some women develop after giving birth. The infection occurs in the lining of the uterus (the endometrium) or the upper genital tract.

This postpartum infection is caused by bacteria. These bacteria may already be inside you before birth, or they can enter during childbirth. Typically, the bacteria come up from the lower genital or gastrointestinal tract. These organisms then enter the endometrial cavity during birth and cause an infection.

Typically, most cases of postpartum endometritis are diagnosed within 10 days of giving birth. However, some cases can take up to 6 weeks to fully develop.

Bacteria of any kind can cause postpartum endometritis. However, the most common culprits are group B streptococci and staphylococcus (staph).

The main symptom of postpartum endometritis is a fever that develops up to 72 hours after giving birth. Other signs of a postpartum infection include:

• Soreness, tenderness, or swelling of the belly or abdomen
• Chills
• Pain while urinating or during sex
• Abnormal vaginal discharge that has a bad smell or blood in it
• A general feeling of discomfort or unwellness
• Headache

If you notice any of these signs, especially if they’re paired with a fever, you may have postpartum endometritis.

Research shows that between 5% and 7% of women develop postpartum infections after giving birth. Any woman can get postpartum endometritis, but the rate of infection is 5–10 times higher in cesarean section (C-section) deliveries than in vaginal deliveries.

Only about 1–3% of women who give birth vaginally develop postpartum endometritis, but 2% of women who undergo planned C-sections and up to 7% for C-sections done when the patient is already in labor, go on to develop the infection. 

Apart from C-sections, other risk factors that contribute to developing postpartum endometritis include:

• Prolonged labor
• Prolonged rupture of the fetal membranes
• Infection during pregnancy
• Internal examinations during labor
• Postpartum hemorrhage 
• Removal of the placenta by hand or incomplete removal
• Bacterial vaginosis
• Newborn stool inside the amniotic fluid

Infections within the first 24 hours of delivery are usually caught while you’re still in the care of medical staff. Outside of this window, you should make an appointment with your doctor if you suspect that you have a postpartum infection.

Your doctor can give you a physical exam and ask about your symptoms to diagnose you. They may perform a vaginal swab, blood test, or urine test to confirm the infection.

Postpartum endometritis is treated with antibiotics. There are several different kinds of antibiotics that are prescribed to treat postpartum endometritis, and most are typically administered with an IV. Occasionally, these antibiotics can be given by injection.

Three of the most effective antibiotics to fight off this type of infection are clindamycin, gentamicin, and ampicillin. Your doctor may prescribe one or a combination of the three.

There are usually no lasting effects if postpartum endometritis is caught and treated quickly. If the infection is left untreated for too long, it could turn into sepsis, an infection that spreads to your bloodstream and can be life threatening. 

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90,000 Postpartum infections. What are Postpartum Infections?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Postpartum infections are a group of diseases of infectious etiology that develop within 6 weeks after childbirth and are directly related to them. Include local wound infections, infections of the pelvic organs, generalized septic infections. In the diagnosis of postpartum infections, the time of their development and connection with childbirth, the picture of peripheral blood, data from a gynecological examination, ultrasound, and bacteriological examination are of paramount importance. Treatment of postpartum infections includes antibiotic therapy, immunostimulating and infusion therapy, extracorporeal detoxification, sanitation of the primary focus, etc.

• Causes of postpartum infections
• Classification of postpartum infections
• Symptoms of postpartum infections
• Diagnosis of postpartum infections
• Treatment of postpartum infections
• Prognosis and prevention
• Prices for treatment

General

Postpartum (puerperal) infections are purulent-inflammatory diseases pathogenetically caused by pregnancy and childbirth. They include wound infections (postpartum ulcers, endometritis), infections limited to the pelvic cavity (metritis, parametritis, salpingo-oophoritis, pelvioperitonitis, metrothrombophlebitis, etc.), diffuse infections (peritonitis, progressive thrombophlebitis) and generalized infections (septic shock, sepsis) . The time frame during which these complications can develop is from the moment the placenta is isolated to the end of the sixth week of the postpartum period. Puerperal diseases of infectious etiology occur in 2-10% of puerperas. Septic complications play a leading role in the structure of maternal mortality, which puts them in a number of priority problems in obstetrics and gynecology.

postpartum infections

Causes of postpartum infections

The occurrence of postpartum infections is due to the penetration of microbial agents through the wound surfaces formed as a result of childbirth. The entrance gate can be ruptures of the perineum, vagina and cervix; the inner surface of the uterus (placental site), postoperative scar during caesarean section. In this case, pathogens can get to the wound surface both from the outside (from the instruments, hands and clothing of personnel, surgical underwear, care items, etc.), and from endogenous foci as a result of the activation of their own opportunistic flora.

The etiological structure of postpartum infections is very dynamic and variable. Of the conditionally pathogenic microorganisms, aerobic bacteria predominate (enterococci, E. coli, staphylococci, group B streptococci, Klebsiella, Proteus), but anaerobes (fusobacteria, bacteroids, peptostreptococci, peptococci) are also quite common. The importance of specific pathogens is great – chlamydia, mycoplasmas, fungi, gonococci, Trichomonas. A feature of postpartum infections is their polyetiology: in more than 80% of cases, microbial associations are sown, which are more pathogenic and resistant to antibiotic therapy.

The risk of developing postpartum infections is significantly increased in women with pathology of pregnancy (anemia, toxicosis) and childbirth (early discharge of water, weak labor, prolonged labor, bleeding, retention of parts of the placenta, lochiometer, etc.), extragenital pathology (tuberculosis, obesity, diabetes diabetes). Endogenous factors predisposing to microbial contamination of the birth canal can be vulvovaginitis, colpitis, cervicitis, pyelonephritis, tonsillitis, sinusitis in the puerperal woman. When infected with a highly virulent flora or a significant decrease in the immune mechanisms in a puerperal, the infection can spread beyond the primary focus by the hematogenous, lymphogenous, intracanalicular, perineural route.

Classification of postpartum infections

Based on the anatomical, topographical and clinical approach, 4 stages of the progression of postpartum infection are distinguished (authors – S. V. Sazonova, A. V. Bartels).

• Stage 1 – local infection that does not spread beyond the area of ​​the wound surface (postpartum ulcer of the perineum, vagina and uterine wall, suppuration of sutures, suppuration of hematomas, postpartum endometritis)
• Stage 2 – postpartum infection that extends beyond the boundaries of the wound surface, but limited to the pelvic cavity (metroendometritis, adnexitis, parametritis, metrothrombophlebitis, limited pelvic thrombophlebitis, pelvioperitonitis)
• Stage 3 – diffuse postpartum infection (peritonitis, progressive thrombophlebitis)
• 4th stage – generalized septic infection (sepsis, infectious-toxic shock).

As a separate form of postpartum infection, lactational mastitis is isolated. The severity of infectious complications after childbirth depends on the virulence of the microflora and the reactivity of the macroorganism, so the course of the disease varies from mild and erased forms to severe and fatal cases.

Symptoms of postpartum infections

A postpartum ulcer is formed as a result of infection of abrasions, cracks and tears in the skin of the perineum, vaginal mucosa and cervix. The clinical picture of this postpartum complication is dominated by local symptoms, the general condition is usually not disturbed, the temperature does not exceed subfebrile figures. The puerperal complains of pain in the suture area, sometimes itching and dysuric phenomena. When examining the birth canal, an ulcer with clear boundaries, local edema and inflammatory hyperemia are found. At the bottom of the ulcer, a grayish-yellow coating, areas of necrosis, and mucopurulent discharge are determined. The ulcer bleeds easily on contact.

Postpartum endometritis (metroendometritis), among other postpartum infections, is the most common – in 36-59% of cases. There are classic, obliterated, abortive forms and metroendometritis after caesarean section. In a typical (classic) variant, postpartum endometritis manifests itself on the 3-5th day after childbirth with a rise in temperature to 38-39 ° C and chills. Locally marked subinvolution of the uterus, its pain on palpation, cloudy purulent discharge from the cervical canal with a fetid odor. The abortive form of postpartum infection develops on days 2-4, but undergoes a rapid regression due to the start of therapy. For the erased course of postpartum endometritis, a late onset (5-8 days), a protracted or undulating course, and less pronounced symptoms are typical. The clinical manifestation of endometritis after delivery by cesarean section falls on days 1-5; pathology proceeds with general and local manifestations.

Postpartum parametritis develops on the 10-12th day when the infection passes to parametrium – periuterine tissue. A typical clinic includes chills, febrile fever, which lasts 7-10 days, intoxication. The puerperal is concerned about pain in the iliac region on the side of inflammation, which gradually increase, radiate to the lower back and sacrum. A few days after the onset of postpartum infection in the area of ​​the lateral surface of the uterus, a painful infiltrate is palpated, first of a soft, and then of a dense consistency, soldered to the uterus. The outcomes of postpartum parametritis may be resorption of the infiltrate or its suppuration with the formation of an abscess. Spontaneous opening of the abscess can occur in the vagina, bladder, uterus, rectum, abdominal cavity.

Postpartum thrombophlebitis can affect superficial and deep veins. In the latter case, the development of metrothrombophlebitis, thrombophlebitis of the veins of the lower extremities and veins of the pelvis is possible. They usually appear within 2-3 weeks after delivery. Clinical harbingers of postpartum complications of this type are prolonged fever; persistent step-like increase in heart rate; pain in the legs when moving and pressing on soft tissues; swelling in the ankles, lower leg or thigh; cyanosis of the lower extremities. The development of metrothrombophlebitis is indicated by tachycardia up to 100 bpm, subinvolution of the uterus, prolonged bleeding, palpation of painful strands along the lateral surfaces of the uterus. Thrombophlebitis of the pelvic veins is dangerous for the development of ileofemoral venous thrombosis and pulmonary embolism.

Postpartum pelvioperitonitis, or inflammation of the peritoneum of the small pelvis, develops 3-4 days after childbirth. The manifestation is acute: the body temperature rises rapidly to 39-40°C, there are sharp pains in the lower abdomen. Vomiting, flatulence, painful defecation may occur. The anterior abdominal wall is tense, the uterus is enlarged. Postpartum infection is resolved by resorption of the infiltrate in the pelvis or the formation of an abscess of the Douglas pouch.

The clinic of diffuse and generalized postpartum infection (peritonitis, sepsis) does not differ from that in infectious diseases of a different etiology. Lactational mastitis is discussed in detail in the section “Diseases of the mammary glands”.

Diagnosis of postpartum infections

Factors indicating the development of postpartum infections are signs of infectious-purulent inflammation in the area of ​​the birth wound or pelvic organs, as well as general septic reactions that occurred in the early period after childbirth (up to 6-8 weeks). Complications such as postpartum ulcers, suppuration of sutures or hematomas are diagnosed based on a visual examination of the birth canal. A vaginal examination allows a gynecologist to suspect postpartum infections of the pelvic organs. In these cases, a delayed contraction of the uterus, its soreness, pastosity of the periuterine space, infiltrates in the small pelvis, and cloudy, fetid discharge from the genital tract are usually found.

Additional data is obtained during a gynecological ultrasound. In case of suspected thrombophlebitis, dopplerography of the pelvic organs, ultrasound of the veins of the lower extremities is indicated. With postpartum endometritis, hysteroscopy is informative; with purulent parametritis – puncture of the posterior fornix of the vagina. According to indications, radiation diagnostic methods are used: phlebography, hysterography, radioisotope research.

All clinical forms of postpartum infection are characterized by a change in the picture of peripheral blood: a significant leukocytosis with a neutrophilic shift to the left, a sharp increase in ESR. In order to identify infectious agents, a bacteriological culture of the discharge of the genital tract and the contents of the uterus is performed. Histological examination of the placenta may indicate signs of inflammation and, therefore, a high likelihood of developing postpartum infections. An important role in planning therapy and assessing the severity of complications is the study of blood biochemistry, acid-base balance, blood electrolytes, and coagulograms.

Treatment of postpartum infections

The whole complex of therapeutic measures for postpartum infections is divided into local and general. Bed rest and applying ice to the abdomen helps stop further spread of the infection from the pelvic cavity.

Local procedures include treatment of wounds with antiseptics, dressings, ointment applications, removal of sutures and opening of the wound in case of suppuration, removal of necrotic tissues, topical application of proteolytic enzymes. With postpartum endometritis, it may be necessary to perform curettage or vacuum aspiration of the uterine cavity (with retention of placental tissue and other pathological inclusions in it), dilation of the cervical canal, aspiration and lavage drainage. When a parametrium abscess is formed, it is opened through the vagina or by laparotomy and drainage of the parauterine tissue.

Local measures for postpartum infections are carried out against the background of intensive general therapy. First of all, antibacterial agents are selected that are active against all isolated pathogens (broad-spectrum penicillins, cephalosporins, aminoglycosides, and others), which are administered intramuscularly or intravenously in combination with metronidazole. At the time of treatment, it is advisable to interrupt breastfeeding. In order to detoxify and eliminate the water-salt imbalance, infusions of colloidal, protein, salt solutions are used. It is possible to carry out extracorporeal detoxification: hemosorption, lymphosorption, plasmapheresis.

In postpartum infections of staphylococcal etiology, in order to increase specific immunological reactivity, antistaphylococcal gamma globulin, staphylococcal toxoid, and antistaphylococcal plasma are used. In order to prevent thrombosis, anticoagulants, thrombolytics, antiplatelet agents are prescribed under the control of a coagulogram. In the complex of drug therapy, antihistamines, vitamins, glucocorticoids are widely used. At the rehabilitation stage, laser therapy, local ultraviolet radiation, UHF therapy, ultrasound, electrical stimulation of the uterus, balneotherapy and other methods of physiotherapy are prescribed.

In some cases, surgical assistance may be required – removal of the uterus (hysterectomy) with its purulent fusion; thrombectomy, embolectomy or phlebectomy – with thrombophlebitis.

Prognosis and prevention

In wound infections and infections limited to the pelvic area, the prognosis is satisfactory. Timely and adequate therapy can stop the further progression of postpartum infections. However, in the long term, the prognosis for reproductive function can be variable. The most severe consequences for the health and life of the puerperal entail diffuse peritonitis, sepsis and septic shock.

Prevention of postpartum infections is ensured by strict and strict observance of the sanitary and hygienic regime in obstetric institutions, the rules of asepsis and antisepsis, and personal hygiene of personnel. Sanitation of endogenous infection at the stage of pregnancy planning is important.

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IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Postpartum complications

After childbirth, the inner surface of the uterus is a vast area of ​​the wound surface, which can get infectious agents that live in our body and around us. It is important that the body responds correctly to the penetration of the infection, but with reduced immunity, it resists weakly.

Postpartum endometritis – inflammation of the walls of the uterus, usually occurs after childbirth with a long anhydrous interval (amniotic fluid has poured out more than 12 hours before the birth of the child) or after a caesarean section. On the 2nd-5th day after spontaneous childbirth (2nd-3rd day after caesarean section), clinical signs of endometritis appear: high body temperature (38-39 degrees), chills, pain in the lower abdomen. In addition, the discharge from the genital tract, which should become paler every day, becomes brighter, a characteristic unpleasant odor appears. For timely prevention and diagnosis of endometritis, 3-5 days after childbirth, do an ultrasound of the uterus. If the diagnosis is confirmed, treatment is carried out in a hospital.

Peritonitis – inflammation of the peritoneum, a thin tissue membrane lining the walls of the abdominal cavity and the organs that are in it. Quite often, the disease occurs after a caesarean section. Clinical manifestations: high body temperature (38-39), chills, headache, severe soreness of the uterus, a symptom of peritoneal irritation (when pressing with a hand on the stomach and then abruptly releasing – severe pain). Often, peritonitis develops against the background of antibacterial therapy initiated in the treatment of postpartum endometritis. In some cases, the intestinal walls begin to pass microorganisms that enter the abdominal cavity, causing intoxication and dehydration.

Sepsis – blood poisoning, a life-threatening condition, accompanied by chills, a sharp rise in body temperature up to 40 – 41, a violation of the functions of all vital organs (respiratory, excretory, cardiovascular and other functions). In sepsis, the primary focus of infection is most often the uterus, but sometimes it happens that it is “replaced” by other sources of infection in the body (dental caries, inflammation of the tonsils or mammary gland, kidneys).

Treatment . If the remains of the placenta or accumulation of blood clots are found in the uterus after childbirth, they are removed. If the primary purulent focus is found in the mammary gland (mastitis), the abscess is opened, the pus is removed and a drainage (rubber tube) is installed to drain the contents. At the same time, general treatment of sepsis is prescribed: detoxification, antibiotic therapy, hormonal support, etc.

Postpartum mastitis is an inflammation of the mammary gland in a woman who is breastfeeding. The most common causative agent of the disease is Staphylococcus aureus. When the first signs of congestion (lactostasis) appear in the mammary gland, you should immediately consult a specialist. Timely treatment of lactostasis can quickly resolve the situation, without leading to mastitis.

As a rule, lactostasis begins with an increase in body temperature (38-39), chills, weakness appear, pain in the mammary gland increases during feeding. The breast increases in volume, the skin over the compacted areas of the gland is inflamed, sharply painful, cracks in the nipples can be observed. With ineffective treatment, the disease progresses, suppuration of the infiltrate occurs. Purulent mastitis is characterized by an increase in body temperature up to 40 degrees, chills, loss of appetite, mother’s refusal to breastfeed.

Treatment . Since the cause of lactostasis is the stagnation of sweet milk in the gland, the baby himself will be the surest remedy. Frequent attachment to the breast, and correct attachment, quickly relieves stagnation, the mammary gland is “cleared” and recovery occurs. In addition, a breast pump is a good helper, which every young mother should have. Properly selected underwear (bra for nursing women), careful hygiene, nipple care are measures to prevent lactostasis and mastitis.