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- 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
- 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
- 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
- Internal fetal monitoring
- Retained products of conception
- Low socioeconomic status
- Urethral catheterization
- Previous UTI
- Nipple fissure
- Breast engorgement
- Diabetes mellitus, poorly controlled
- Immunosuppressive therapy
- Immunodeficiency disorder
- Nutritional status
- 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]