Back حمى النفاس Arabic Doğuş zamanı temperatur Azerbaijani প্রসোবত্তর সংক্রমণ Bengali/Bangla Infecció puerperal Catalan Horečka omladnic Czech Kindbettfieber German Infección puerperal Spanish Infekzio puerperal Basque تب نفاسی Persian Fièvre puerpérale French
| Postpartum infections | |
|---|---|
| Other names | Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections |
 | |
| Streptococcus pyogenes (red-stained spheres) is responsible for many cases of severe puerperal fever. (900× magnification) | |
| Specialty | Obstetrics |
| Symptoms | Fever, lower abdominal pain, bad-smelling vaginal discharge[1] |
| Causes | Typically multiple types of bacteria[1] |
| Risk factors | Cesarean section, premature rupture of membranes, prolonged labour, malnutrition, diabetes[1][2] |
| Treatment | Antibiotics[1] |
| Frequency | 11.8 million[3] |
| Deaths | 17,900[4] |
Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage.[1] Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge.[1] It usually occurs after the first 24 hours and within the first ten days following delivery.[5]
The most common infection is that of the uterus and surrounding tissues known as puerperal sepsis, postpartum metritis, or postpartum endometritis.[1][6] Risk factors include caesarean section (C-section), the presence of certain bacteria such as group B streptococcus in the vagina, premature rupture of membranes, multiple vaginal exams, manual removal of the placenta, and prolonged labour among others.[1][2] Most infections involve a number of types of bacteria.[1] Diagnosis is rarely helped by culturing of the vagina or blood.[1] In those who do not improve, medical imaging may be required.[1] Other causes of fever following delivery include breast engorgement, urinary tract infections, infections of an abdominal incision or an episiotomy, and atelectasis.[1][2]
Due to the risks following caesarean section, it is recommended that all women receive a preventive dose of antibiotics such as ampicillin around the time of surgery.[1] Treatment of established infections is with antibiotics, with most people improving in two to three days.[1] In those with mild disease, oral antibiotics may be used; otherwise intravenous antibiotics are recommended.[1] Common antibiotics include a combination of ampicillin and gentamicin following vaginal delivery or clindamycin and gentamicin in those who have had a C-section.[1] In those who are not improving with appropriate treatment, other complications such as an abscess should be considered.[1]
In 2015, about 11.8 million maternal infections occurred.[3] In the developed world about 1% to 2% develop uterine infections following vaginal delivery.[1] This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[1] In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[4][7] They are the cause of about 10% of deaths around the time of pregnancy.[2] The first known descriptions of the condition date back to at least the 5th century BCE in the writings of Hippocrates.[8] These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[9] In 1847, Hungarian physician Ignaz Semmelweiss decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of handwashing with calcium hypochlorite.[10][11]
- ^ a b c d e f g h i j k l m n o p q r s "37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8.
- ^ a b c d WHO recommendations for prevention and treatment of maternal peripartum infections (PDF). World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3. PMID 26598777. Archived (PDF) from the original on 2016-02-07.
- ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
- ^ a b GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
- ^ Hiralal Konar (2014). DC Dutta's Textbook of Obstetrics. JP Medical Ltd. p. 432. ISBN 978-93-5152-067-2. Archived from the original on 2015-12-08.
- ^ "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290. ISBN 978-1-4557-7558-3.
- ^ GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
- ^ Walvekar V (2005). Manual of perinatal infections. New Delhi: Jaypee Bros. p. 153. ISBN 978-81-8061-472-9. Archived from the original on 2016-03-04.
- ^ Magner LN (1992). A history of medicine. New York: Dekker. pp. 257–258. ISBN 978-0-8247-8673-1.
- ^ Anderson BL (April 2014). "Puerperal group A streptococcal infection: beyond Semmelweis". Obstetrics and Gynecology. 123 (4): 874–882. doi:10.1097/aog.0000000000000175. PMID 24785617. S2CID 24685091.
- ^ Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). "Medicine in stamps-Ignaz Semmelweis and Puerperal Fever". Journal of the Turkish German Gynecological Association. 14 (1): 35–9. doi:10.5152/jtgga.2013.08. PMC 3881728. PMID 24592068.