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- Postpartum fever or puerperal fever is defined as an oral temperature of 38°C (100.4°F) on two separate occasions at least 4 hours apart or of >38.5°C (101.6°F) at any time. This may occur any time from rupture of membranes to 42 days after delivery (1).
- Postpartum fever is a sign that requires investigation to determine the specific etiology, which will then dictate treatment.
- Also called postpartum pyrexia or puerperal fever
Etiology and Pathophysiology
- Pathophysiology depends on the cause and site.
- Most commonly from surgical site infections, endometritis, or the breast (1)
- Pelvic and wound infections are caused by polymicrobial vaginal anaerobic and aerobic pathogens (2,3).
- Breast infections arise from skin flora such as Staphylococcus and Streptococcus (4).
- Cesarean deliveries
- Operative vaginal delivery
- Epidural analgesia
- Long operative duration
- Increased duration of active labor
- Membranes ruptured for >6 hours or preterm rupture of membranes
- Multiple pelvic examinations during labor
- Positive GBS status
- Preexisting infection with bacterial vaginosis
- Internal fetal monitoring
- Retained products of conception
- Low socioeconomic status
- Urethral catheterization
- Nipple fissure
- Breast engorgement
- Diabetes mellitus, poorly controlled
- Immunosuppressive therapy
- Immunodeficiency disorder
- Nutritional status
- Appropriate sterile technique during labor and delivery
- Cesarean sections—recommend 2 g of IV cefazolin just prior to incision (5)[A]; adjunctive 500 mg of IV azithromycin for nonelective cesarean sections (5)[A]
- Vaginal cleansing prior to a nonelective cesarean section in laboring patients with ruptured membranes using a povidone-iodine solution (5)[A]