Puerperal Sepsis: Symptoms, Causes, Risks & Treatment

Puerperal infection, also called postpartum infection, is the infection of the genital tract occurring during labour or within 42 days of the postpartum period. It is a bacterial infection that occurs in the uterus and its surroundings following childbirth. It is the third most common cause of maternal death worldwide. Compared to puerperal sepsis, "puerperal infection" is more inclusive of all extra-genital illnesses as well as accidental infections.

What is puerperal sepsis? Read on to learn more.

Types of puerperal infections

It is described based on three areas where it can occur:

1. Endometritis:

uterine lining It is the most common area of infection.

2. Myometritis:

uterine muscle

3. Parametritis:

tissues around the uterus

Symptoms of puerperal sepsis

General symptoms of puerperal sepsis include:

• Pain in the area of the pelvic bones or below the waist due to an irritated uterus.

• Pale, clammy skin is indicative of significant blood loss.

• Stench-filled vaginal drainage that indicates an infection

• Faster heartbeat due to blood loss

The onset of symptoms could take many days. Infections can occasionally go undetected until after discharge from the hospital. Even after being let go, it's crucial to keep an eye out for infections.

Signs of puerperal infection are similar to those of a typical bacterial infection:

• Fever

• Chills

• Body pain

• Loss of appetite

• Discomfort

Causes of puerperal sepsis

A healthy uterus is sterile. Bacteria such as Streptococcus or Staphylococcus, and other skin-dwelling bacteria, can cause infections by entering injured skin or tissue. The lower abdomen's warm, humid environment is ideal for these bacteria to grow.

Following the mother's labour, postpartum infections may begin in the uterus. Additionally, if the amniotic sac and its fluid contract an infection, the uterus may also do so. The membrane enclosing the foetus and its fluids is known as the amniotic sac.

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Risk factors of puerperal sepsis

The risk factor depends on the type of childbirth.

• Natural delivery: lowest risk

• Scheduled c-section delivery: moderate risk

• Non-scheduled c-section deliveries: highest risk

Common risk factors include:

• Pregnancy in very old or very young women

• Obesity

• High blood pressure

• Anaemia

• compromised immune system

Other risk factors include:

• Multiple vaginal examinations throughout labour

• Monitoring the foetus inside the uterus

• Prolonged labour or delayed rupture of the amniotic sac

• Removal of the placenta manually

• incomplete removal of the placenta after delivery

• Babies poop in the placenta after delivery.

• Use of a catheter during delivery

• STDs or other bacterial infections of the vagina

How is a puerperal infection identified?

Puerperal infection is identified by physical examination. The signs and symptoms are not seen immediately. The patient is asked to check for any increase in body temperature, bleeding, or foul-smelling vaginal discharge.

If required, a blood test can be done to check for the level of WBC. It tells us if the body is fighting an infection. Early identification can prevent it from progressing to septic shock.

What complications are caused by puerperal sepsis?

Puerperal sepsis complications occur when the infection is not identified at an early stage.

Possible complications include:

• Pus formation

• swelling of the stomach lining

• Pelvic vein blood clot

• Blood clot formation can further cause blockage in vital organs.

• and septic shock, which is the last and most severe stage of infection. At this stage, very low levels of blood pressure are seen.

Treatment for puerperal sepsis

Puerperal sepsis is treated by giving antibiotics through the veins while the patient is still in the hospital. Medications called broad-spectrum antibiotics are preferred. They act against a large variety of bacteria when the type of bacteria is not known. If any symptoms are seen after hospital discharge, readmission may be required for treatment.

Once the infection is under control, oral antibiotics are given. During this time, the blood and urine bacteria are cultivated to identify the bacteria that is causing them. Rule out other causes of infection, such as retained bits of the placenta. Start IV fluids to prevent organ damage.

What are the chances of getting puerperal infections?

The chance of getting an infection depends on the risk factors. The chances are lower in natural deliveries and higher in c-sections. Various other factors increase the risk. 5–7% of women develop post-birth infections. These infections, when mild, can be treated, and the patient recovers well. Delay in treatment is what increases the susceptibility to sepsis.

How to prevent puerperal infections?

Certain things can be done to reduce the chances of getting a puerperal infection in women with c-section deliveries. These include:

• Use of a tweezer to remove pubic hair

• Taking a bath with an antibacterial soap the night before the surgery.

• Keeping low blood sugar levels during pregnancy

During the surgery, the surgeon takes the following steps to prevent infection:

• Disinfecting the areas of incision

• Before the surgery, one dose of antibiotics is administered.

• Giving a full course of antibiotics for bacterial vaginosis

For mothers who are to undergo a c-section delivery, it is important to know about infections like puerperal sepsis and consult a doctor.