Postpartum infections usually begin in the uterus. They may develop if the membranes containing the fetus (amniotic sac) are infected and cause a fever during labor. These infections include infection of the uterine lining (endometritis), uterine muscle (myometritis), or areas around the uterus (parametritis).
Bacteria that normally live in the healthy vagina can cause an infection after delivery. Conditions that make a woman more likely to develop an infection include the following:
The chances of developing a uterine infection depend mainly on the type of delivery:
Symptoms commonly include pain in the lower abdomen or pelvis, fever (usually within 1 to 3 days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. The heart rate is often rapid. The uterus is swollen, tender, and soft. Typically, there is a malodorous discharge from the vagina, which varies in amount. But sometimes the only symptom is a low-grade fever.
When the tissues around the uterus are infected, they swell, causing significant discomfort. Women typically have severe pain and a high fever.
Some severe complications can occur but not often. They include the following:
In sepsis and septic shock, blood pressure falls dramatically and the heart rate is very rapid. Severe kidney damage and even death may result. These complications are rare, especially when postpartum fever is diagnosed and treated promptly.
An infection may be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have a fever and no other cause is identified.
Usually, doctors take a sample of urine and send it to be cultured and checked for bacteria.
If the uterus is infected, women are usually given antibiotics (usually clindamycin plus gentamicin) intravenously until they have had no fever for at least 48 hours. Afterward, most women do not need to take antibiotics by mouth.
Before a cesarean delivery, doctors may give women antibiotics shortly before surgery. Such treatment can help prevent infections of the uterus and the areas around it.
Last full review/revision May 2013 by Julie S. Moldenhauer, MD