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    Postpartum Fever

    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

    Stephens, Mark B., et al., editors. "Postpartum Fever." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816959/all/Postpartum_Fever.
    Postpartum Fever. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816959/all/Postpartum_Fever. Accessed April 21, 2019.
    Postpartum Fever. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816959/all/Postpartum_Fever
    Postpartum Fever [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816959/all/Postpartum_Fever.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Postpartum Fever ID - 816959 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, 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 -