Written by Dr.M.D.Mazumdar, MD
Causes of Postpartum Infection
- Infection of the episiotomy wound or any lacerations of the vagina, vulva or the cervix. The episiotomy is a small incision made on the edge of the vaginal opening to make it larger and make it easier for the baby's head to be delivered. Sepsis of this incision can lead to postpartum infection.
- Infection of the placental site by bacteria traveling up from the vagina.
This is commonly seen in cases of prolonged labour, after repeated vaginal examinations in unsterile conditions, intrauterine manipulations as in manual removal of placenta after retained placenta, rupture of membranes not adequately covered by antibiotics, and sometimes in cesarian sections.
This is the commonest cause of postpartum infection.
- Infections of other pelvic organs like the ovaries, peritoneum and the broad ligament, secondary to pelvic infections.
- Infections spreading from a sore throat or infected gums through the blood or from the anus during delivery.
- Infections carried to the patient from doctors, nurses and other visitors.
- Infection can also spread from infected vaginal pads. Clean vaginal sterile pads should be used instead of home made cloth pads to avoid postpartum infection.
Signs and Symptoms of Postpartum Infection
- Fever: Temperature of 100 degrees Fahrenheit (38 degrees Centigrade) or greater at any time during the postpartum period calls for a thorough examination and investigation of the patient. The temperature may sometimes go as high as 105 degrees and may be accompanied by chills and rigor.
- Pain: Pain may be present along the episiotomy stitches or over the lacerations in case of infection. The patient will invariably complain of a deep discomfort or ache in the pelvis while walking around or during any other movement of her body. Deep abdominal pain may occur in widespread pelvic infections during the postpartum period. The pain may be moderate to strong abdominal or back pain that is more than just an ache. There may also be nausea and vomiting.
- Episotomy Wound Infection: Infection may cause increased pain, swelling, redness, or drainage from the episiotomy incision.
- Infection of the Uterus and Surrounding Tissues: A foul smelling vaginal discharge accompanied by increased bleeding and increasing tenderness in the lower abdomen is suggestive of infection in the uterus and surrounding tissues. A woman who complains of bleeding through more than one pad per hour or passage of large blood clots should be investigated for infection.
- Breast infection: Infection in the breast may set in after breast engorgement resulting in formation of a breast abscess. The breasts may be red, warm to the touch and painful.
- General symptoms: like vomiting, headache, loss of appetite, and general malaise may be present. The patient may complain of a severe weakness. She may be extremely pale with a rapid, racing pulse.
Examination of the vulva and vagina may reveal infected wounds, presence of pus and inflamed and indurated areas around the wound.
- Palpation of the abdomen will cause deep tenderness in case of widespread pelvic infections.
- On Bimanual Vaginal Examination for postpartum genital infections, the uterus may be found to be sub-involuted - that is, it may not have become as small as it should have been for that time after the delivery or abortion. The patient will feel pain on movement of the uterus. In cases of infections of the para-uterine tissues, a tender inflammatory mass may be detected deep in the pelvis.
Tests for Postpartum Infection
Blood examination will show a rise in the number of WBCs (white blood cells) and in the ESR level indicating an infection.
Ultrasonography: In mild infections, there may not be any abnormality in the USG. But if the infection affects the tissues around the uterus resulting in a deep pelvic infecion, USG may reveal a mass with ill-defined margins.
Management / Treatment of Postpartum Infections
- Bed rest.
- Fluids: Plenty of fluids to counteract dehydration. IV fluids are given if the patient cannot take adequate fluids orally.
- Good nourishing diet.
- If the infection is severe, the baby must be isolated from the mother. A breast pump can be used to express the milk to prevent breast engorgement and breast abscess. But in mild cases, it is better to keep them together.
- Medicines : Antibiotics to counteract the infection, analgesics for the pain, sedatives and vitamin supplements.
Local treatment of Postpartum Infections:If perineal wounds like episiotomies are infected, the stitches should be removed to drain out the pus.
If the infection is due to retained tissues in the uterus, they should be removed as gently as possible.
However, if the uterus is deemed to be too friable and there is a possibility of rupture during removal, it is better not to manipulate it any further. Removal can be done after 2 or 3 days of starting antibiotics.
Clean vaginal pads must be used and changed frequently.
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