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Definition Puerperal infection is a bacterial infection that occurs following childbirth. The infection may also be referred to as puerperal or postpartum fever. Puerperal fever was a feared disease throughout Europe of women who delivered a child in a public hospital. In developing nations, the death rate due to puerperal infection is estimated to be 100 times higher. Causes and symptoms The primary symptom of puerperal infection is a fever at any point between birth and 10 days postpartum. A temperature of 100.4° F (38° C) on any two days during this period, or a fever of 101.6° F (38.6 ° C) in the first 24 hours postpartum, is cause for suspicion. Many of these bacteria are normally found in the mother's genital tract, but other bacteria may be introduced from the woman's intestine and skin or from a healthcare provider. Causes of postpartum fever include urinary tract infections, wound infections, septic thrombophlebitis, and mastitis. Mastitis, or breast infection, is indicated by fever, malaise, achy muscles, and reddened skin on the affected breast. It is usually caused by a clogged milk duct that becomes infected. Infections of the urinary tract are indicated by fever, frequent and painful urination, and back pain. Treatment Antibiotic therapy is the mainstay of treatment in puerperal infection. Hospitalization may or may not be necessary. Clindamycin and gentamicin may be used as initial therapy, as they are broad-spectrum antibiotics, that is, covering more than one organism. Ampicillin may be added if symptoms persist. If an abscess has been diagnosed, surgical drainage may be required. In the presence of thrombophlebitis, heparin therapy will be needed to provide anticoagulation. Diagnosis of puerperal infection is made on the basis of the presenting symptoms, which must be thoroughly investigated. In addition, diagnostic testing may include a complete blood count, chest x-ray, urinalysis, or wound culture. High vaginal or endocervical cultures are not helpful in identifying a uterine pathogen, and transabdominal uterine aspiration is not recommended, as it may only serve to spread the infection. Blood cultures may be done, but they are only positive 8% of the time.
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