Definition

The postpartum period is the recovery phase following childbirth, during which a woman's reproductive organs return to their pre-pregnancy state before the next pregnancy. This period typically lasts about 6 to 8 weeks after delivery. The duration of the postpartum period is the same for women who have given birth vaginally or via cesarean section, although a cesarean section involves additional changes to the mother's body. These changes primarily affect organs involved in pregnancy and childbirth, such as the uterus, cervix, and vagina. During the postpartum period, these organs gradually return to their pre-pregnancy condition.

Postpartum infections, also known as puerperal infections, include various infections that can occur after childbirth, whether it was a vaginal delivery, a cesarean section, or during breastfeeding. The pain experienced by new mothers often makes it difficult to distinguish postpartum infections from regular postpartum pain.

These infections commonly occur in the uterus following childbirth. The uterus can become infected if the amniotic sac was infected. Typically, the bacteria causing the infection originate from the normal flora of the skin, such as Streptococcus or Staphylococcus, and other bacteria, supported by the warm and moist conditions. Some common postpartum infections include:

• Endometritis: an infection of the endometrium or the layer of the uterus.
  
  • Endometritis can occur after childbirth and affect the layer of the uterus or the upper genital tract. It is caused by bacteria that may have been present before birth or entered during delivery. These bacteria typically enter from the lower genital tract or the gastrointestinal tract.
  • Postpartum endometritis is usually diagnosed within 10 days after delivery, although in some cases, it may take up to 6 weeks to develop.
  • Common bacteria involved in this infection include Group B Streptococcus and Staphylococcus.
• Mastitis, or breast infection
  
  • This infection occurs when bacteria enter the nipple area, often due to cracked nipples from breastfeeding. It is commonly caused by Staphylococcus bacteria.
• Infected Cesarean Section Incisions
  
  • This is a common infection following a cesarean section. It is caused by Staphylococcus bacteria at the surgical site within 30 days after surgery.
• Urinary Tract Infections (UTIs)
  
  • UTIs occur in about 2-4% of pregnancies.

If you want to read more about urinary tract infections, you can read them here: Infection of the Ministry of Manpower Channel (ISK) - Control, Cause, Symptoms, and Treatment.

Risk Factor

The risk factors for postpartum infections can vary depending on the method of delivery. The risk of experiencing a postpartum infection is as follows:

• 1-3% for vaginal deliveries
• 5-15% for planned cesarean sections before labor begins
• 15-20% for unplanned cesarean sections after labor has started

Other risk factors that can increase the chances of a postpartum infection include:

• Anemia
• Obesity
• Bacterial vaginosis
• Multiple vaginal examinations before delivery
• Internal fetal monitoring
• Prolonged labor
• A long interval between the rupture of membranes and delivery
• Group B Streptococcus colonization in the vaginal tract
• Retained placental fragments after delivery
• Excessive bleeding post-delivery
• Young maternal age (under 20 years)

Symptoms

Symptoms of postpartum infections may take several days to appear. Some infections may not be immediately apparent and may only become noticeable after the mother has been discharged from the hospital. It's important to be aware of signs of infection, particularly after leaving the hospital. Common symptoms of postpartum infections include:

• Fever and flu-like symptoms
•  A fever within the first three days after delivery can indicate that the body is fighting an infection. The mother may also feel weak, experience chills, have a headache, or feel more hungry than usual.
• Pain in the lower abdomen or back due to uterine swelling
• Foul-smelling vaginal discharge
• This may indicate an abnormal condition in the body
• Pale skin, which can signal significant blood loss
• Chills
• Discomfort or pain
• Headache
• Loss of appetite
• Palpitations

Diagnosis

A doctor will inquire about the patient's medical and treatment history and conduct a physical examination. The doctor may also request laboratory tests, such as urine or blood samples, to check for bacteria or use swabs to collect a culture from the uterus.

Management

Postpartum infections are generally treated with oral antibiotics. The doctor may prescribe antibiotics such as clindamycin or gentamicin. The antibiotics are targeted at the specific type of bacteria suspected to be causing the infection. Most antibiotics prescribed for postpartum infections are safe to use while breastfeeding.

If you want to read about Gentamisin antibiotics, you can read them here: Gentamisin - How To Work, Contraindication, Side Effects.

Complications

Complications from postpartum infections are generally rare but can occur if the infection is not promptly diagnosed and treated. Some potential complications include:

• Abscesses, which are pockets filled with pus
• Peritonitis, which is inflammation of the protective lining of the abdominal organs
• Pelvic thrombophlebitis, which is a blood clot in a vein in the pelvis
• Embolism, which is a blockage of a blood vessel
• Sepsis or septic shock, which occurs when bacteria enter the bloodstream and cause life-threatening inflammation

Prevention

Postpartum infections often occur in unclean environments or areas with poor healthcare quality. A lack of caution and concern from healthcare providers or inadequate sanitation systems can increase the risk of infection.

For postpartum infections, the method of delivery is an important risk factor. If a mother knows that she will undergo a cesarean section, she should consult with her doctor about the steps the hospital will take to prevent infection. Some steps to reduce the risk of postpartum infection before a cesarean section include:

• Taking an antiseptic bath on the morning of the surgery
• Removing pubic hair with clippers rather than shaving
• Using chlorhexidine alcohol on the skin to be operated on
• Taking broad-spectrum antibiotics before the surgery

Many hospitals have adopted these measures to minimize the risk of infection. Additionally, it is important for pregnant women to be aware of the symptoms and risks of infection if they are undergoing either a planned or unplanned cesarean section. Immediately contact a doctor if an infection is suspected so that it can be promptly diagnosed and treated.

When to See a Doctor?

A mother should see a doctor immediately if she suspects any signs of infection. In rare cases, infections can lead to life-threatening reactions like sepsis. A mother should seek immediate medical attention if she experiences any symptoms related to infection, such as fever, chills, rapid breathing, a fast heartbeat, confusion, or severe pain.

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