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 4 hours apart or of >38.5°C (101.6°F) at any time. This may occur any time from rupture of membranes to 42 days after delivery (1).
  • Postpartum fever is a sign that requires investigation to determine the specific etiology, which will then dictate treatment.
  • Also called postpartum pyrexia or puerperal fever

Epidemiology

Incidence
  • A complication in 5–7% of postpartum women (1)
  • 10–15% of scheduled cesarean deliveries (2)
  • 15–20% of unscheduled cesarean deliveries (2)

Etiology and Pathophysiology

  • Pathophysiology depends on the cause and site.
  • Most commonly from surgical site infections, endometritis, or the breast (1)
  • Pelvic and wound infections are caused by polymicrobial vaginal anaerobic and aerobic pathogens (2,3).
  • Breast infections arise from skin flora such as Staphylococcus and Streptococcus (4).

Risk Factors

  • Cesarean deliveries
  • Operative vaginal delivery
  • Epidural analgesia
  • Long operative duration
  • Increased duration of active labor
  • Membranes ruptured for >6 hours or preterm rupture of membranes
  • Multiple pelvic examinations during labor
  • Positive GBS status
  • Preexisting infection with bacterial vaginosis
  • Internal fetal monitoring
  • Retained products of conception
  • Low socioeconomic status
  • Urethral catheterization
  • Obesity
  • Smoking
  • Intubation
  • Nipple fissure
  • Breastfeeding
  • Breast engorgement
  • Diabetes mellitus, poorly controlled
  • Immunosuppressive therapy
  • Immunodeficiency disorder
  • Nutritional status

General Prevention

  • Appropriate sterile technique during labor and delivery
  • Cesarean sections—recommend 2 g of IV cefazolin just prior to incision (5)[A]; adjunctive 500 mg of IV azithromycin for nonelective cesarean sections (5)[A]
  • Vaginal cleansing prior to a nonelective cesarean section in laboring patients with ruptured membranes using a povidone-iodine solution (5)[A]

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