Postpartum Fever is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Postpartum fever or puerperal fever is defined as an oral temperature of 38°C (100.4°F) on two separate occasions at least 6 hours apart or of >38.5°C (101.6°F) at any time.
  • Postpartum fever is a sign that requires investigation to determine the specific etiology, which will then dictate treatment.
  • Puerperal fever—fever that occurs in the postpartum period starting from after delivery to up to 6 weeks postpartum

Epidemiology

Incidence
  • A complication in 2–4% of vaginal deliveries
  • 5–15% of scheduled cesarean deliveries
  • 15–20% of unscheduled cesarean deliveries

Etiology and Pathophysiology

  • Pathophysiology depends on cause and site.
  • Pelvic infections associated with vaginal pathogens that then lead to ascending genital tract infection
  • Breast infections arise from skin flora
  • Wound infection resulting from vaginal or cesarean delivery

Risk Factors

  • Cesarean deliveries
  • Operative vaginal delivery
  • Long operative duration
  • Increased duration of active labor
  • Membranes ruptured for >6 hours or preterm rupture of membranes
  • Multiple pelvic examinations during labor
  • Chorioamnionitis
  • Endometritis
  • Internal fetal monitoring
  • Retained products of conception
  • Multiparity
  • Low socioeconomic status
  • Urethral catheterization
  • Previous UTI
  • Obesity
  • Smoking
  • Intubation
  • Nipple fissure
  • Breastfeeding
  • Breast engorgement
  • Diabetes mellitus, poorly controlled
  • Anemia
  • Immunosuppressive therapy
  • Immunodeficiency disorder
  • Nutritional status

General Prevention

  • No general prevention for vaginal deliveries other than appropriate sterile technique during labor and delivery
  • Once chorioamnionitis is diagnosed, antibiotics should be administered to reduce neonatal and maternal hospital stay.
  • Cesarean sections—recommend 2 g of IV cefazolin or, if PCN allergy, 900 mg of IV clindamycin ± 1 g of IV vancomycin just prior to incision will reduce infection rate to <5% (1)[C]; adjunctive 500 mg of IV azithromycin prior to incision for nonelective cesarean section (2)[B]

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Postpartum Fever ID - 816959 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816959/all/Postpartum_Fever PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -