Puerperal infection: a risk after delivery

Puerperal infection (or maternal sepsis in English) is polymicrobial and occurs in the mother during the puerperium, that is, a few days after giving birth. The World Health Organization (WHO) estimates that, out of every 1000 births, 11 women suffer infections that cause death or bring them closer to it.

The reason for the puerperal infection is that commensal bacterial colonies or symbionts of the vaginal tract infiltrate internal tissues and spread, as a consequence of physiological stress during delivery. If you want to know more about this serious medical situation, keep reading.

Symptoms of puerperal infection

Puerperal infection was common years ago. However, thanks to the effective use of antibiotics and the sanitization of the material during delivery, this condition is increasingly rare in high-income countries. Some of the signs of it are as follows:

  • Chills and general ill feeling.
  • Pain in the lower abdomen.
  • Smelly vaginal discharge.
  • Vaginal bleeding
  • Dizziness and fainting

As indicated by the portal MSDmanuals, all these clinical signs are usually accompanied by severe fever (24-48 hours postpartum), headaches and anorexia. In more severe cases, tachycardia, leukocytosis (increased white blood cells) and inflammation of the pelvic walls can also be recorded.

Puerperal infections are related to the characteristics of childbirth and hygiene conditions.

Possible complications

An uncontrolled puerperal infection can cause microorganisms to colonize the blood and multiply in other organs. This is called bacteremia, which constitutes a severe condition that endangers the life of the patient.

Septicemia is usually the immune response (just as uncontrolled) to systemic infection. This leads to a shock septic causing death in 40% of cases.

To know more: Frequent infections during pregnancy

Causes of puerperal infection

The infection occurs when commensal bacteria or symbionts from the vaginal tract take advantage of the opportunity to infiltrate the mother's postpartum wounds. They tend to be polymicrobial, that is, with several species present. Among them we find the following:

  • Gram-positive cocci: group B streptococci, group A streptococci (GAS), Staphylococcus epidermidis and species of Enterococcus.
  • Anaerobes: that grow in the absence of oxygen, as strains of the genera Bacteroides and of Prevotella.
  • Gram negative bacteria: Gardnerella vaginalis, Escherichia coli, Klebsiella pneumoniae Y Proteus mirabilis.

Bacteria can permeate surgical instruments during delivery and enter the mother's deep tissues during the procedure. On the other hand, the causative agent may have entered the body normally (mouth-nose), but It takes advantage of the weakened immune state to multiply itself.

A third option, the most common of all, is for bacteria found in the vaginal tract to enter internal tissues through wounds produced during childbirth.

Prevalence and risk factors

As indicated by portal studies PubMed, in high-income countries, there are only 0.1 to 0.6 cases of puerperal infection per 1000 births. Globally, a much higher number is estimated, 11 per 1,000.

The probability of suffering from this clinical picture also depends a lot on the method by which the delivery was performed. The statistics are distributed as follows:

  • Vaginal deliveries: incidence of 1 to 3%.
  • Scheduled cesarean sections: 5 to 15%.
  • Unscheduled caesarean sections: 15 to 20%.

This does not mean that an unscheduled cesarean will cause a puerperal infection 1 out of 4 times. Using broad-spectrum antibiotics can prevent the overgrowth of bacterial colonies, even before serious clinical signs appear.

Among the risk factors we find the following:

  • Long deliveries.
  • Caesarean sections that get complicated.
  • Postpartum hemorrhages.
  • Bacterial Vaginosis.
  • Young maternal age.
  • Retention of placental fragments in the uterus.

Diagnosis

In general, this is a rule-of-thumb diagnosis. After the first 24 hours after delivery, a puerperal infection should be suspected when there are no obvious causes for a fever over 38 °C sustained in the mother for 2 days.

If other pathologies are ruled out, blood and urine cultures are performed to find out how far the bacteria have reached. On the other hand, analysis of samples from the cervix is ​​rarely performed, as it is assumed that it will be contaminated with microorganisms.

Treatment of puerperal infection

Treatment of puerperal infection is based on intravenous injection of high-spectrum antibiotics. These drugs are usually clindamycin plus gentamicin, with or without ampicillin. As scientific studies indicate, the intravenous approach is recommended until the woman is afebrile for 48 hours in a row.

In the case of tissue remains in the uterus, a curettage is used in order to remove the waste from it. This prevents bacteria from proliferating again when the antibiotic treatment is finished.

Cesarean sections present a higher risk of leading to puerperal infection than natural vaginal deliveries.

Prevention

Preventing or minimizing predisposing factors for infection is essential. According to the portal NSW Goverment HealthCorrect hygiene during this delicate period is essential for the well-being of the mother. Among the tips to follow we find the following:

  • Daily showers, in order to keep the perineum clean.
  • Sanitize and dry the perineum area so that bacteria from the rectum cannot spread to the vaginal area.
  • Do not use tampons until directed by a doctor.
  • Wash your hands with soap for at least 15 seconds before coming into contact with any instrument of a maternal nature.

You may be interested in: Veiled labor: how does this phenomenon occur?

Puerperal infection is a geographic problem

Today, puerperal infection is a disease that hardly ever needs to be worried about. If medical professionals perceive a risk of it happening, they proceed to preventive antibiotic therapy, which reduces the probabilities by 75%.

Unfortunately, not all geographic areas can say the same. In countries with fewer public health structures, the mortality of newly delivered mothers increases dramatically, since the lack of means makes an uncontrolled infection much more frequent.