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]