What Is Puerperal Fever?

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Puerperal fever is a term that was used in the early 18th century to describe what we today call a postpartum infection. Postpartum infection is a bacterial infection of the reproductive organs that occurs up to 10 days after a pregnant person gives birth.

Infections of the reproductive organs can occur from any vaginal delivery, but more commonly occur from birth trauma or from a surgical procedure required to remove the infant from the womb during delivery, called a cesarean delivery (C-section).

This article reviews the types, symptoms, causes, and treatment of puerperal fever.

Woman in hospital bed after giving birth

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Types of Postpartum Infections

Before the advent of surgical procedures to assist with difficult infant deliveries, puerperal fever mainly referred to an infection inside the pelvis from the trauma of the baby moving through the birth canal. It was most likely a disease of the uterine lining (endometrium).

An infection of the endometrium is called endometritis. Postpartum people can develop several different infections of the reproductive organs, including some related to surgery. However, the most common is still endometritis.

Postpartum people can also develop:

  • Wound infections at the surgical site from a C-section
  • Urinary tract infections (UTIs)
  • Inflammation or infection of breast tissue, called mastitis
  • Wound infections at the site of an episiotomy (a surgical cut made in the perineum, between the vagina and anus, to enlarge the opening for the baby to pass through)
  • Septic pelvic thrombophlebitis, a rare infection that travels through the veins from the pelvis to the rest of the body

Infection After C-Section

Postpartum people undergoing cesarean delivery are at higher risk for puerperal fever or postpartum infection.

Puerperal Fever Symptoms

A temperature at or above 100.4 degrees Fahrenheit within 10 days of delivering a baby may indicate puerperal fever or postpartum infection.

The First 24 Hours

A postpartum fever is not consider a puerperal fever if it occurs in the first 24 hours after delivery. This is because it's common for people to develop a low-grade fever during this time and not have an infection. This type of fever resolves on its own.

Endometritis

People with endometritis develop a fever with lower abdominal pain, uterine tenderness, and an elevated heart rate. People will often have vaginal bleeding and a foul odor coming from the vagina.

Wound Infection

Wound infections typically present with redness, warmth, and pain at the incision site. These can occur at the cesarean incision or the episiotomy site. Sometimes there is white or yellow discharge from the incision.

A severe infection can spread deeper into the abdominal cavity. Or, the skin may turn black and blue and peel away.

Urinary Tract Infection

People often complain of pain and burning with urination when they develop a UTI. Other symptoms can include lower abdominal pain and fever.

What Causes Puerperal Fever?

There are several risks to developing an infection after delivering a baby. People who undergo a C-section are at a higher risk for a postpartum infection than people who have a vaginal delivery.

Other risk factors include:

Endometritis

Endometritis is an infection of the uterine lining. The uterine lining, along with the fallopian tubes and ovaries, is part of the upper genital tract. During delivery, bacteria usually found in the lower genital tract (the vagina and cervix) can access the upper genital tract and cause inflammation.

People who have a cesarean delivery are 5 to 10 times more likely to develop endometritis. Other risk factors for this infection include:

  • Prolonged rupture of membranes for longer than 18 hours
  • Testing positive for group B streptococcus in the vaginal area
  • Chorioamnionitis (an infection of the placenta and the amniotic fluid)
  • Prolonged time in surgery for a C-section
  • Use of an internal monitoring probe during labor
  • Multiple vaginal exams

Chlamydia Infection

If a postpartum person develops endometritis more than seven days after delivery, there is a higher likelihood that the infection is caused by Chlamydia trachomatis, an STI.

Wound Infection

Postoperative wound and episiotomy site infections are often caused by skin bacteria such as Staphylococcus or Streptococcus.

However, the frequency of postoperative wound infections has significantly declined since the introduction of sterile cleansers used on the skin and antibiotics given before the procedure.

Other risk factors for a wound infection include:

  • A history of diabetes
  • A history of obesity
  • Regular use of corticosteroids (anti-inflammatory drugs)
  • Smoking

Urinary Tract Infection

People who have a C-section are at higher risk for developing a UTI, most often due to bladder catheterization during the operation.

Catheterization is a procedure in which a tube is inserted into the urethra to collect urine from the bladder. The most common organism that leads to a bladder infection is Escherichia coli, or E. coli.

Diagnosis

Postpartum infections are most often diagnosed based on a healthcare provider's examination and the patient’s risk factors for specific conditions.

If a person has a persistent fever while taking antibiotics for a postpartum infection or has suspected disease that has spread throughout the body, providers will perform laboratory tests and other imaging studies to look for the source of the infection. They might also perform these tests and studies to ensure something different is not causing the fever

Treatment

Different types of bacteria cause postpartum infections. Antibiotics treat all of the various conditions. The choice of antibiotic depends on the infection location and the bacteria most likely causing the infection.

Healthcare providers also treat fevers with pain relievers like acetaminophen and ibuprofen. In the hospital, they will often give people intravenous fluids. The postpartum person also needs to rest.

Preventive Treatment

People who are undergoing a C-section should be proactively given a dose of antibiotics before the procedure to prevent postoperative wound infections and endometritis.

Endometritis

The initial antibiotic choice to treat endometritis is clindamycin plus gentamicin. People with endometritis often require a stay in the hospital to receive intravenous antibiotics.

Wound Infection

Wound infections are also treated with antibiotics. The choice of antibiotic depends on the most likely bacteria causing the infection and antibiotic resistance patterns in the community where the person lives.

When the condition is caught early, people can take antibiotics at home and do not need to stay in the hospital.

Urinary Tract Infection

Healthcare providers are likely to treat a UTI in a postpartum person with antibiotics, even if they look well and have minimal symptoms. This is especially true in patients who underwent bladder catheterization during their C-section.

Prognosis

If endometritis or a significant wound infection is not detected in an appropriate amount of time, the infection can lead to the formation of an abscess, spread throughout the rest of the abdominal area, or spread to blood vessels that carry the infection to the rest of the body.

These infections can be life-threatening, but antibiotics significantly reduce the likelihood of severe infection and death from the disease.

Future Infertility

People who develop endometritis are at risk for future infertility.

Summary

Puerperal fever, also known as postpartum infection, refers to an infection of the reproductive organs several days after delivering a baby. The most common of these infections is endometritis. Other types of infections include wound infections and urinary tract infections. If the conditions are not recognized and treated appropriately, they can be life-threatening. Antibiotics treat them all, and generally these postpartum infections resolve.

A Word From Verywell

Developing a fever after delivering a baby is stressful, especially because the infection takes you away from time with your new baby. Postpartum infections are much more easily treated when antibiotics are started early. If you develop a fever within 10 days of delivering your baby, speak to a healthcare provider, including your obstetrician, about what to do next.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hallett C. The attempt to understand puerperal fever in the eighteenth and early nineteenth centuries: the influence of inflammation theory. Med Hist. 2005;49(1):1-28. doi:10.1017/s0025727300000119

  2. Dalton E, Castillo E. Postpartum infections: a review for the non-OBGYN. Obstet Med. 2014;7(3):98-102. doi:10.1177/1753495X14522784

  3. MedlinePlus. Endometritis.

  4. Daifotis HA, Smith MM, Denoble AE, Dotters-Katz SK. Risk factors for postpartum maternal infection following spontaneous vaginal delivery complicated by chorioamnionitisAJP Rep. 2020;10(02):e159-e164. doi:10.1055/s-0040-1709983

  5. Gundersen TD, Krebs L, Loekkegaard ECL, Rasmussen SC, et al. Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study. BMJ Open. 2018;8(3):e018479. doi:10.1136/bmjopen-2017-018479

  6. Mackeen A, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database of Systematic Reviews. 2015;2:CD001067. doi:10.1002/14651858.CD001067.pub3

By Christine Zink, MD
Dr. Christine Zink, MD, is a board-certified emergency medicine with expertise in the wilderness and global medicine. She completed her medical training at Weill Cornell Medical College and residency in emergency medicine at New York-Presbyterian Hospital. She utilizes 15-years of clinical experience in her medical writing.