After delivery, the uterus may become infected if the membranes containing the fetus (amniotic sac) are infected (called chorioamnionitis).
Uterine infections include
Causes
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:
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A long delay (often more than 18 hours) between rupture of the membranes and delivery
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Internal monitoring of the fetus (which requires rupture of the membranes containing the fetus)
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Repeated vaginal examinations during labor
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Placental fragments remaining in the uterus after delivery
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Excessive bleeding after delivery (postpartum hemorrhage)
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Young age
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Low socioeconomic group
The chances of developing a uterine infection depend mainly on the type of delivery:
Symptoms
Symptoms of uterine infections 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 foul-smelling discharge from the vagina, which varies in amount. The discharge may or may not contain blood. 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:
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Inflammation of the membranes that line the abdomen (peritonitis)
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Blood clots in the pelvic veins (pelvic thrombophlebitis)
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A blood clot that travels to the lung and blocks an artery there (pulmonary embolism)
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High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis (a bodywide infection) or septic shock
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A pocket of pus (abscess) in the pelvis
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.
Diagnosis
An infection of the uterus may be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have had a fever for 24 hours after delivery and no other cause is identified.
Usually, doctors take a sample of urine examine, analyze it (urinalysis), and send it to be cultured and checked for bacteria. Urine tests can help identify urinary tract infections.
Other tests are rarely needed but may include culturing a sample of tissue taken from the lining of the uterus and imaging tests, usually computed tomography, of the abdomen.
Treatment
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.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
clindamycin |
CLEOCIN |
gentamicin |
GENOPTIC |
