A puerperal infection is defined as an infection in the mother during the first six weeks after delivery which is the period known as puerperium. A range of pathogens have been identified as potential causative agents, and various risk factors have been reported. Early recognition through a detailed clinical workup is mandatory, as sepsis and shock can develop and be fatal in the absence of proper therapy.
Puerperal infection (also referred to as postpartum infection in the literature) represents maternal infection within six weeks after delivery, a period also known as the puerperium. Several risk factors have been established - prolonged rupture of membranes, postpartum hemorrhage (PPH), preexisting chorioamnionitis, the need for a cesarean section, anemia, primiparity and giving birth in unhygienic conditions (for example, home birth)   . A majority of the risk factors are related to birth-related events with most of the infections developing within 24 hours after labor . However, one of the main factors in the pathogenesis of puerperal infections is the lack of adequate postnatal follow-up, which leads to delayed recognition and increased risk for complications . The presence of a high fever (> 38°) is one of the most important signs of a puerperal infection, while additional symptoms are related to the type of infection   :
Because life-threatening sepsis and shock may develop from puerperal infections, an early diagnosis is pivotal in reducing maternal morbidity and mortality . For this reason, the appearance of fever during the puerperium must raise suspicion about an infectious etiology. Firstly, a thorough patient history should be obtained, including information about the delivery (particularly if a cesarean section was performed), preexisting comorbidities and risk factors, as well as evaluation of additional symptoms, if present. A detailed physical exam could potentially determine the focus of the infection by observing localized pain, tenderness, swelling or other organ-specific symptoms , after which a complete laboratory workup is advised. A complete blood count (CBC), serum inflammatory markers (C-reactive protein and erythrocyte sedimentation rate, or CRP and ESR, respectively), a full coagulation panel, urinalysis, and kidney function tests must be included in the initial workup . In addition, microbiological testing for blood, urine, or breast milk cultures, and wound and genital swabs, is recommended  . Besides bacterial organisms, influenza and human immunodeficiency (HIV) viruses have been established as important causes of maternal mortality, suggesting that the clinical workup should also assess lung function, and appropriate serological or molecular testing should be performed in the presence of a suspicion of HIV or influenza infection .