Infections of the Uterus After Delivery

The Uterus, Cervix, and Cervic...

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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:

• A long delay (often more than 18 hours) between rupture of the membranes and delivery

• Prolonged labor

• Repeated cervical examinations during labor

• Chorioamnionitis

• Internal monitoring of the fetus (which requires rupture of the membranes containing the fetus)

• Cesarean delivery

• Placental fragments remaining in the uterus after delivery

• Manual removal of fragments remaining in the uterus after delivery

• Excessive bleeding after delivery (postpartum hemorrhage)

• Establishment of bacteria (colonization) in the lower part of the genital tract (vulva, vagina, or cervix)

• Bacterial vaginosis

• Anemia

• Diabetes

• Young age

• Low socioeconomic group

The chances of developing a uterine infection depend mainly on the type of delivery:

• Normal vaginal deliveries: 1 to 3%

• Cesarean deliveries that have been scheduled and are done before labor starts: 5 to 15%

• Cesarean deliveries that are not scheduled and are done after labor starts: 15 to 20%

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:

• Inflammation of the membranes that line the abdomen (peritonitis)

• Blood clots in the pelvic veins (pelvic thrombophlebitis)

• A blood clot that travels to the lung and blocks an artery there (pulmonary embolism)

• High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis (a bodywide infection) or septic shock

• 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.

An abscess in the pelvis may feel like a palpable lump or cause a fever and abdominal pain.

These complications are rare, especially when postpartum fever is diagnosed and treated promptly.

• A doctor's evaluation

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 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.

• Antibiotics given intravenously

If the uterus is infected, women are usually given antibiotics by vein (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.