Postpartum infections: bacterial infections of the genital tract after delivery

Postpartum infections are on the decline thanks to antibiotics to prevent dyspareunia, but let’s know what kind of disease it is.

Postpartum infection or maternal sepsis is a polymicrobial infection that can occur immediately after delivery and later in the postpartum period. The World Health Organization (WHO) estimates that for every 1,000 births, about 11 mothers die or are threatened with death from postpartum infections.

Postpartum infection occurs when a group of genital commensal bacteria or symbiotic bacteria that have penetrated into the tissues spread through physiological stress during childbirth. Continue reading to learn more about life-threatening postpartum infections.

Postpartum infection symptoms

Postpartum infections used to be a common disease, but thanks to hygiene management during childbirth and the effective use of antibiotics, it has become a rare symptom in high-income countries. Symptoms of fatal postpartum infections include:

• chills and discomfort
• lower abdominal pain
• foul-smelling vaginal discharge
• vaginal bleeding
• dizziness and fainting

According to the MSD manual, the above clinical symptoms are accompanied by high fever 24 to 48 hours after delivery, and headache and anorexia symptoms also appear. As the condition becomes more severe, palpitations, leukocytosis, and swelling of the pelvic wall appear.

Postpartum infection is closely related to the delivery method and hygiene conditions.

possible complications

Uncontrolled postpartum infections cause bacteria to colonize in the blood and multiply in other organs. In other words, it becomes a very critical condition called bacteremia.

Sepsis usually refers to an uncontrolled systemic inflammatory response, leading to septic shock, in which 40% of patients die.

Causes of puerperal infections

If bacteria infect the mother’s genital wounds during childbirth, it can worsen into postpartum infection, which can be caused by various bacteria as follows.

• Gram-positive cocci : group B streptococci, group A streptococci (GAS), staphylococcus epidermidis and enterococci
• Anaerobic bacteria : Bacteria that can grow in the absence of oxygen, such as Bacteroides and Prevotella.
• Gram-negative bacteria : Gardella, Escherichia coli, Bacillus pneumoniae and Proteus bacilli

Bacteria can enter the oral cavity or nasal cavity when surgical instruments are contaminated during childbirth, genital wounds are infected with bacteria from the stomach, or immunity is weakened.

However, the most common cause of postpartum infection is an infection of the genital wound during labor.

Fashion and risk factors

According to the ‘PubMed’ site, the number of puerperal infections worldwide is 11 per 1,000 births, but only 0.1 to 0.6 cases occur in high-income countries.

Postpartum infection is greatly affected by the delivery method, and the statistics are as follows.

• Natural delivery : 1-3%
• Planned cesarean section: 5-15% of cases
• Unscheduled cesarean section: 15-20% of cases

Of course, the above statistics are not accurate. This is because the use of broad-spectrum antibiotics can prevent the overgrowth of bacterial populations and thus prevent the worsening of symptoms.

The following are risk factors that increase the risk of puerperal infections:

• delivery delay
• complex cesarean section
• bleeding after delivery
• bacterial vaginosis
• young mother
• Residual placental fragments in the uterus

Diagnosis and treatment

Postpartum infections are diagnosed using an exclusion diagnostic method. If an unexplained high fever of 38 degrees Celsius or higher continues for more than two days 24 hours after delivery, the doctor may suspect the mother’s postpartum infection.

After excluding possible diseases, the bacterial status is checked with blood and urine tests, but uterine samples that are already infected are rarely tested.

Postpartum infections are based on broad-spectrum antibiotic injections, usually with ampicillin added to clindamycin and gentamicin. Studies suggest that antibiotic injections should be continued until fever-free for 48 hours.

If there is residual tissue in the uterus, it must be removed by curettage surgery to prevent infection even after antibiotic treatment is finished.

Cesarean section has a higher incidence of postpartum infections than vaginal delivery.

prevention

Preventing infection or minimizing risk factors is fundamental. The website of the New South Wales Department of Health, Australia, states that proper hygiene during childbirth is critical to a mother’s well-being and provides the following guidelines:

• Take a shower every day and take care of your perineum
• Clean and dry the perineum so that germs from the anus do not spread to the genitals.
• Do not use tampons without medical permission
• Wash hands with soap for at least 15 seconds before handling maternity items

Postpartum infections are a local problem

In recent years, the puerperal infection has become a rare disease, and prophylactic antibiotic therapy can reduce the incidence by as much as 75%.

Unfortunately, the incidence of puerperal infections varies widely between regions. Maternal mortality is high in countries with poor health hygiene and scarce resources such as antibiotics.