Bacteria can infect the uterus and surrounding areas soon after delivery.
Such infections commonly cause pain in the lower abdomen, fever, and a foul-smelling discharge.
Diagnosis is usually based on symptoms and results of a physical examination.
Antibiotics usually cure the infection.
After delivery, the uterus may become infected if the membranes containing the fetus (amniotic sac) are infected (called chorioamnionitis Intra-Amniotic Infection Intra-amniotic infection is infection of the tissues around the fetus, such as the fluid that surrounds the fetus (amniotic fluid), the placenta, the membranes around the fetus, or a combination... read more ).
Uterine infections include
Infection of the uterine lining (endometritis)
Infection of uterine muscle (myometritis)
Infection of the areas around the uterus (parametritis)
Causes of Postpartum Uterine Infections
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
Internal monitoring of the fetus Fetal monitoring Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more (which requires rupture of the membranes containing the fetus)
Repeated vaginal examinations during labor
Placental fragments remaining in the uterus after delivery
Excessive bleeding after delivery Excessive Uterine Bleeding at Delivery Excessive bleeding from the uterus refers to loss of more than 2 pints of blood or symptoms of significant blood loss that occur within 24 hours of delivery. After the baby is delivered, excessive... read more (postpartum hemorrhage)
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 Postpartum Uterine Infections
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:
A blood clot that travels to the lung and blocks an artery there (pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism is the blocking of an artery of the lung (pulmonary artery) by a collection of solid material brought through the bloodstream (embolus)—usually a blood clot (thrombus) or... read more )
High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more (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. These complications are rare, especially when postpartum fever is diagnosed and treated promptly.
Diagnosis of Postpartum Uterine Infections
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 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 of Postpartum Uterine Infections
Antibiotics given intravenously
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.