Introduction
Pregnancy-related morbidity and mortality are global socioeconomic and healthcare burdens, and postpartum infections account for a significant and often preventable portion of that burden. The postpartum period is traditionally defined as the 6 weeks following delivery, and infections are relatively common, affecting an estimated 5% to 7% of patients during this time. Puerperal sepsis is one of the top 5 causes of pregnancy-related deaths worldwide and accounts for 10% to 15% of deaths in the postpartum period.
In the United States, sepsis complicates 4 in 10,000 live births, but it is the second leading cause of peripartum death. Rates of postpartum sepsis continue to increase.[1] In over 60% of these cases, delays in recognition or management occur, and an estimated 63% of parental deaths from sepsis may have been prevented.[2][3][2] Infections are also the most common cause of death following spontaneous or induced abortions. The medical burden of these infections is compounded by the alarmingly rapid increase in bacterial resistance to commonly used antibiotics.[4]
Postpartum infections also present a significant social burden as they increase parental anxiety, the risk of postpartum depression, interfere with bonding, and can negatively impact breastfeeding.[5][6] Postpartum infections discussed in this course include infections that occur after live births, stillbirths, and spontaneous or induced abortions. Mastitis is not included in this discussion, as it does not directly result from pregnancy or delivery.
Etiology
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Etiology
Most postpartum infections arise from physiologic or iatrogenic trauma to the abdominal wall and the reproductive, genital, or urinary tract during childbirth or abortion. This trauma can disrupt normal barriers and facilitate the spread of bacteria into deeper tissues or sites where infection can develop.
Epidemiology
Studying rates of postpartum infections and their effects is difficult, as most of these infections occur following hospital discharge. Trends toward decreasing hospital stay following childbirth further inhibit the detection of postpartum complications, including infection.[7] Available data shows that postpartum infections account for 19% of birthing persons' deaths following stillbirth and 34% following spontaneous or induced abortions.[8]
The latest data from the Centers for Disease Control show that infections disproportionately affect ethnic minorities and are the leading cause of pregnancy-related deaths among Hispanic people in the United States.[9] On the whole, postpartum infections are more common in patients who underwent cesarean section as opposed to vaginal delivery, and the risk is further increased for patients who underwent labor before the cesarean section.[10] Approximately 1% to 3% of patients with uncomplicated vaginal deliveries will be diagnosed with postpartum endometritis.[11]
The risk of postpartum infections is likewise increased in patients at the extremes of age or with high body mass index, diabetes, hypertension, or immune compromise. As the BMI increases, the risk of postcesarean wound infection also increases.[12] Patients with bacterial vaginosis or sexually transmitted infections, as well as group-B streptococcus (GBS) carriers, also have an increased risk of postpartum infections.[13] Birth events associated with increased risk of infection include preterm or post-term labor, prolonged rupture of membranes, prolonged labor,
HIV infection, thick meconium stained amniotic fluid, operative vaginal delivery, retained products of conception, use of a foley catheter, uterine cleaning at cesarean section, manual removal of the placenta, uterine instrumentation, and postpartum hemorrhage.[14][11] Frequent vaginal exams in labor and internal fetal or uterine monitoring may also increase the risk, although this has been debated.[13]
Pathophysiology
Postpartum infections can be roughly grouped into those caused by ascending vaginal microflora into the reproductive tract and those which result from iatrogenic trauma to the abdominal wall or perineum during delivery.
Ascending Reproductive Tract Infection
Infections resulting from ascending infection into the reproductive tract include endomyometritis and septic abortion. Endomyometritis is an infection of the endometrium and myometrium. This infection typically occurs during the postpartum period, as childbirth allows ascending vaginal bacterial flora to infect the upper reproductive tract. This infection is 5 to 10 times more common following cesarean delivery as compared to vaginal delivery.[15]
Other risk factors include rupture of membranes for more than 18 hours, chorioamnionitis, bacterial vaginosis, and maternal colonization with group A streptococcus (GAS) or GBS.[15] Anaerobes and aerobes are involved in approximately 60% to 70% of postpartum endometritis cases, indicating that this is a polymicrobial infection.[11] The most common pathogens are those typically associated with the reproductive and urinary tracts, including GBS, enterococci, Escherichia coli, and Klebsiella pneumoniae.[15] Chlamydia trachomatis should be suspected in endometritis presenting >7 days postpartum and in high-risk populations, eg, people younger than 25.
Septic Abortion
Septic abortion is an infection of the products of conception following spontaneous or induced abortion.[16] Septic abortions result from the migration of vaginal flora through an open cervical os following an abortion, resulting in infection of the products of conception. Infection may also spread to the uterus. Septic abortions are associated with a high risk of bacteremia, as the infection can enter the blood supply through the intervillous space of the placenta.[17]
Mortality from septic abortion is directly correlated with gestational age at the time of pregnancy termination. As the pregnancy progresses, the placenta enlarges, and there is more tissue to become infected; thus, mortality from septic abortion increases with increasing gestational age.[16] Because they are both caused by ascending urogenital flora, the microbiological profiles of endomyometritis and septic abortions are similar. However, because of the devitalized tissue present in septic abortions, infections with anaerobic bacteria are more common in this setting.[16]
Surgical Site Infections
Surgical site infections (SSIs) are relatively common following birth, complicating 2% to 7% of cesarean deliveries.[18] Episiotomy or perineal laceration sites can also become infected. SSIs can be broadly divided into deep organ infections and incisional infections. These can be further divided into superficial incisional (involving the skin or subcutaneous tissues) and deep incisional (involving the muscle or fascia) infections.[19] Endomyometritis following surgical delivery is an example of a deep organ infection. Other postpartum deep site infections include infected hematomas and pelvic abscesses.[20] A history of prior cesarean section is correlated with an increased risk of incisional site infection, likely secondary to baseline poor vascularization of the scar tissue from the prior surgery.[21]
Incisional Site Infections
Incisional site infections typically present with erythema and purulent drainage at the site. They can be associated with systemic symptoms, eg, fever and malaise. Like endomyometritis and septic abortion, SSIs can be caused by contamination of the wound with microflora from the genitourinary tract; however, they can also be caused by common skin flora.[22] GAS or GBS most commonly causes infections occurring within the first 2 postoperative days. Other commonly isolated pathogens include Ureaplasma urealyticum, Enterococcus faecalis, Escherichia coli, Proteus mirabilis, and Staphylococcal species.[20][22]
Necrotizing Fasciitis
Rarely, necrotizing fasciitis of the surgical site can develop, characterized by rapid necrosis of the fascia and subcutaneous tissue with relative sparing of the musculature. Postpartum patients who develop necrotizing fasciitis typically have underlying medical comorbidities, with diabetes being the most commonly reported. Type I necrotizing fasciitis results from polymicrobial infection with aerobic and anaerobic organisms. Type II results from infection with GAS. Both types can occur in the postpartum period and can complicate cesarean deliveries as well as episiotomies and perineal lacerations.[23][24][25]
History and Physical
Postpartum Infection Clincal Features
In addition to the standard components of a patient's history, several critical details require attention when evaluating for postpartum infections, including:
- Time since delivery or abortion
- Mode of delivery (eg, surgical or vaginal)
- Episiotomy or laceration
- Prior surgical and medical history
- Gestational age at the time of the delivery or abortion
- Complications of the pregnancy, including gestational diabetes, intrapartum infections, prelabor or prolonged rupture of membranes, chorioamnionitis, or preeclampsia/eclampsia
- Complications of the delivery, including prolonged labor, need for operative vaginal delivery, unplanned cesarean section, and postpartum hemorrhage
- GBS status
- Presence of foul-smelling lochia or excessive vaginal bleeding
A thorough physical examination plays a vital role in identifying postpartum infections. Inspection of any surgical incision, laceration, or episiotomy site allows for the detection of early signs of infection. The skin should be examined for findings, eg, crepitance, bullae, erythema, induration, or drainage. Abdominal palpation and assessment of uterine fundal tenderness can signal uterine involvement. A speculum and bimanual examination assist in evaluating the cervix, vagina, and uterus more directly.
Ascending reproductive tract infection
In endomyometritis, fever is often the first sign, with uterine tenderness and foul-smelling lochia as additional signs. Patients presenting with signs of severe systemic illness, shock, or abdominal pain out of proportion to examination findings should raise suspicion for infection with GAS, which can cause endomyometritis associated with toxic shock syndrome as well as necrotizing fasciitis.[16] Normal physiologic changes in the postpartum patient may make it challenging to recognize sepsis in a recently-delivered patient promptly.[3]
Septic abortion
Fever is common in septic abortion, but may not be present.[16] Frequently, only mild abdominal pain is present, although generalized peritonitis can be seen with severe infection.[16] In addition to GAS, septic abortion associated with sepsis or shock can also occur in the setting of infection with Clostridium species or toxin-producing strains of Escherichia coli.[16]
Incisional infections
Superficial incisional site infections typically present with erythema, warmth, and pain at the site; purulent drainage may also be present.[26] These infections most commonly occur 4 to 7 days following surgery. As mentioned above, signs of infection in the first 48 hours should raise suspicion for group A or B streptococci.[20]
Deep incisional infections may show minimal external examination findings; in fact, pain out of proportion to examination is a hallmark of necrotizing fasciitis. Unlike superficial site infections, deep incisional infections are more likely to be associated with fever and hemodynamic compromise.[20] The examination may reveal skin necrosis, ecchymosis, crepitus, and bullae.[20] Imaging studies may show gas in the soft tissues, but definitive diagnosis and management are surgical. Surgery should not be delayed for diagnostic studies, as these infections are rapidly progressive and fatal if not managed promptly.
Septic pelvic thrombophlebitis and other pelvic infections
Septic pelvic thrombophlebitis (SPT) should be suspected in patients with persistent fever in a spiking pattern, despite adequate antibiotic therapy for the above conditions for more than 3 to 5 days.[20] Deep organ infections, eg, an infected hematoma or pelvic abscess, should likewise be considered if the patient is not responding to appropriate antibiotics.[20][27]
Evaluation
As with all infectious conditions, evaluation should include blood and wound cultures before initiating antibiotics, if time permits. Laboratory findings typical of infection include leukocytosis with neutrophilia and a left shift, as well as lactic acidosis. Notably, no postpartum infection can be ruled out based solely on laboratory work, and clinicians should not be falsely reassured if laboratory diagnostics are unremarkable.
Clinicians should maintain a high index of suspicion for sepsis in pregnant or postpartum patients who exhibit unexplained end-organ dysfunction alongside a suspected or confirmed infection, even if fever is not present.[2] Endomyometritis is largely a clinical diagnosis. Findings suggestive of endomyometritis include fever, abdominal tenderness, and foul-smelling lochia. If septic abortion is suspected based on history, an ultrasound should be obtained to evaluate for retained products of conception.[16]
If the infection has spread to the uterus, gas may be visible in the myometrium on plain film or computed tomography (CT) scans.[16] Surgical site infections are likewise a clinical diagnosis suggested by history and physical examination. If postsurgical deep organ infection is suspected, CT with intravenous contrast may help with diagnosis. Workup and treatment for septic pelvic thrombophlebitis should be initiated if the patient does not defervesce following 3 to 5 days of appropriate broad-spectrum antibiotics. SPT will be diagnosed in up to 20% of patients with prolonged febrile morbidity, defined as a fever for more than 5 days. Pelvic vein thrombosis is typically seen radiologically with CT or magnetic resonance imaging (MRI).[28][27]
Treatment / Management
Knowledge of the microbiological profiles of different postpartum infections, local resistance patterns, and the severity of the patient's illness should guide antibiotic choices. As a general rule, antibiotic regimens, particularly in very sick patients, should initially have a broad spectrum of antimicrobial coverage and be narrowed as more clinical evidence from cultures or pathology specimens becomes available. Pharmacists can often help tailor initial antibiotic choices and aid in narrowing the spectrum as care progresses. Consideration should be given to whether the patient is breastfeeding, and all efforts should be made to use antibiotics that will allow the patient to continue breastfeeding safely.
While antibiotic regimens may vary for specific postpartum infections, the foundation of treating most infectious conditions remains the same. In patients with hemodynamic compromise, balanced crystalloid fluids should be given to a maximum of 30 ml/kg of ideal body weight.[29] If the mean arterial pressure remains persistently below 65 mmHg despite adequate fluid resuscitation, a vasopressor should be initiated.[29] Norepinephrine is recommended as the first-line treatment in the postpartum timeframe.[2](B3)
Broad-spectrum antibiotics should be given as soon as possible, and blood cultures should be obtained before antibiotic administration if doing so does not significantly delay antibiotics.[29] If the infection requires surgical intervention, prompt consultation with a surgical service is of utmost importance. If continued vasopressor therapy is needed, intravenous (IV) corticosteroids should be used. Pharmacologic prevention of VTE should also be used in postpartum patients. Insulin should be started in these critically ill patients if blood sugars are over 180 mg/dL.[2](B3)
The treatment of endomyometritis varies with severity. Patients with mild, early endometritis may be eligible for outpatient treatment; shared decision-making between the clinician and the patient should always precede the decision to treat on an outpatient basis. Intramuscular and oral regimens can also be used in low-resource settings where IV antibiotics may not be an option. Potential 14-day regimens for treatment of postpartum endomyometritis include clindamycin 600 mg orally every 6 hours plus gentamicin intramuscularly 4.5 mg/kg every 24 hours; amoxicillin-clavulanate 875 mg orally twice daily; cefotetan 2g intramuscularly every 8 hours; meropenem or imipenem-cilastatin 500 mg intramuscularly every 8 hours; or oral amoxicillin 500 mg and metronidazole 500 mg every 8 hours.[30] (A1)
The above regimens are safe for breastfeeding patients and result in a >85% cure rate in early endometritis.[30] As with all patients receiving outpatient treatment, strict return precautions should be given for patients who experience worsening symptoms. In patients who will receive IV therapy for endometritis, the empiric combination of clindamycin (900 mg every 8 hours or 600 mg every 6 hours) and gentamicin (5 mg/kg daily or 1.5 mg/kg every 8 hours) is most effective.[31] Ampicillin (2 g IV every 6 hours) can be added for better coverage of enterococcus and in patients who are GBS positive, as there is increasing resistance to clindamycin among GBS isolates.[20][31] An alternative regimen of ampicillin/sulbactam (3 g IV every 6 hours) may be used.[32] Parenteral therapy should continue until the patient deferveses for 24 to 28 hours and their pain improves. Improvement should be seen by 48 to 96 hours. If the patient does not improve, consider a pelvic abscess or infected hematoma, septic pelvic thrombophlebitis, or infection with enterococcus. (A1)
The mainstay of treatment for septic abortion is the removal of the infected products of conception. Broad-spectrum antibiotics should be initiated within an hour of making the diagnosis.[33] In addition to the clindamycin and gentamicin with or without ampicillin regimen mentioned above, other parenteral regimens include ampicillin (2 g every 8 hours), gentamicin (5 mg/kg daily), and metronidazole (500 mg every 12 hours); levofloxacin (500 mg every 12 hours) and metronidazole (500 mg every 12 hours); imipenem (500 mg every 6 hours); piperacillin-tazobactam (4.5 g every 8 hours); or ticarcillin-clavulanate (3.1g every 4 hours).[16] In cases not complicated by a pelvic abscess, IV antibiotics should be continued until 48 hours after the patient shows clinical improvement.[34](A1)
Mild superficial surgical infections that lack systemic symptoms or purulence generally respond well to an oral course of antibiotics. In the absence of purulent drainage, a first-generation cephalosporin, eg, cephalexin, provides effective coverage.[35] When superficial purulence appears without signs of a deeper abscess, clinicians should consider the possibility of methicillin-resistant Staphylococcus aureus (MRSA) and adjust antibiotic coverage accordingly.[36] If the area of erythema and induration measures <5 cm from the incision and systemic signs of infection develop or clinical concern arises for an underlying abscess, the wound requires immediate attention. Opening the site, exploring the tissue, obtaining cultures, and packing the wound with moist gauze—changed twice daily—supports both diagnostic clarity and therapeutic drainage.[35] Empiric antibiotics targeting the genitourinary flora, as previously described, should be initiated in these cases.
Necrotizing fasciitis demands urgent surgical management and cannot be adequately treated with antibiotics alone. While awaiting emergent surgical intervention, immediate initiation of broad-spectrum antibiotic therapy remains essential. A frequently recommended regimen includes vancomycin combined with piperacillin-tazobactam and clindamycin, the latter selected for its ability to suppress bacterial toxin production. This aggressive approach aims to stabilize the patient and limit progression before definitive surgical debridement.[37](A1)
Finally, treatment for septic pelvic thrombophlebitis consists of IV ampicillin (2 g, then 1 g every 4 hours), gentamicin (5 mg/kg daily), and clindamycin (900 mg every 8 hours).[28] Lovenox may be added to this regimen.
Prevention Measures
Before delivery, interventions can be taken to reduce a patient's risk of infection. Shaving before delivery should be avoided, and patients should be counseled on this before their expected delivery date. Clipping or depilatory creams may be used if desired.[38][39] In patients with planned surgical delivery, the CDC recommends preoperative showering the night before the procedure. Further skin cleansing has not been shown to decrease infection rates.[40][39] Chlorhexidine or soap may be used.[26][38] Clinicians should pay special attention to dosing preoperative antibiotics according to the patient's weight, as many antibiotics require a dose increase in obese patients.[41] Weight-based IV cefazolin should be given within 60 minutes before the skin incision, using 1 to 2 g for patients without obesity, and 2 g for those with obesity or weighing 80 kg or more. For individuals in labor or with ruptured membranes, an additional 500 mg of IV azithromycin is advised.[39]
The American College of Obstetricians and Gynecologists (ACOG) does not recommend continued antibiotic therapy after routine cesarean delivery. However, additional antibiotics should be administered in the following cases: patients with obesity who did not receive preoperative azithromycin, if the cesarean section lasts 4 hours or more, if blood loss exceeds 1500 mL, and in those with chorioamnionitis. The Foley catheter, if used, should be removed immediately postpartum for scheduled cesarean deliveries.[42] Preparation of both the vaginal and abdominal skin areas should be done using chlorhexidine (preferred) or povidone-iodine. An alcohol-based agent should be used to prepare the skin at the anticipated incision site.[26] For cesarean deliveries, preparation of the vagina with a 4% chlorhexidine solution has been shown to reduce the risk of endometritis.[38] Routine use of an indwelling urinary catheter is not required, and the use of nonadhesive surgical drapes is advised.[39] The use of antibacterial sutures at the time of cesarean does not affect rates of postpartum sepsis.[43] Peripartum glycemic control is also important; while hypoglycemia should be avoided, evidence has shown that maintaining blood sugar <200 mg/dL is associated with a decrease in surgical site infections.[44] (B2)
During labor, limiting vaginal examinations during labor and avoiding internal fetal monitoring, if possible, may decrease the risk of postpartum infections, although this recommendation has been challenged.[13] Manual extraction of the placenta should be avoided when possible.[38] Meticulous hand washing, strict adherence to sterile techniques, and limiting operating room traffic can likewise decrease the patient's risk for infection.[26]
Due to the increased risk of postpartum infection with manual removal of the placenta, the World Health Organization recommends 1 dose of either ampicillin 2 g IV plus metronidazole 500 mg IV or cefazolin 1 g IV plus metronidazole 500 mg IV. If intrapartum ampicillin has already been given, then 1 dose of IV metronidazole 500 mg can be used before manual placental removal. However, ACOG, the Royal College of Obstetricians and Gynecologists (RCOG), and the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) do not recommend such prophylaxis before manual removal of a placenta. Notably, following bimanual examination or manual removal of intracavitary blood and clots, no professional societies recommend antibiotics.[11](B2)
Evidence on the risk of infection and use of antibiotics for postpartum manual vacuum aspiration (MVA) or dilation and curettage is limited. However, studies from first-trimester aspiration procedures reveal a clear risk of infection, supporting the use of prophylactic antibiotics. The antibiotic regimens used for first-trimester aspiration can help guide recommendations for postpartum procedures. Based on available data, administering a single dose of 500 mg metronidazole IV before postpartum dilation and curettage or MVA is reasonable. If the patient has not already received antibiotics for GBS, a single dose of ampicillin 2 g IV may also be considered. This approach is preferred over antibiotic regimens used in first-trimester aspiration procedures because it better targets the bacteria commonly involved in postpartum endometritis.[11](B2)
Several studies have looked at whether antibiotics help reduce the risk of endometritis after using an intrauterine balloon tamponade. Since prophylactic antibiotics show a clear benefit in this setting, applying the same approach to intrauterine vacuum devices used for hemorrhage control is reasonable. The WHO recommends a single dose of either ampicillin 2 g IV or amoxicillin-clavulanate 1 g IV after balloon placement. However, other major organizations, eg, ACOG, RCOG, and RANZCOG, do not provide specific guidance on antibiotic use in this context.[11](B2)
Finally, outbreaks of GAS infection in postpartum women have often been linked to colonized or infected healthcare practitioners, prompting the CDC to recommend healthcare worker screening when 2 or more episodes of postpartum GAS infection cases are identified over 6 months.[45](B3)
Differential Diagnosis
Postpartum fever is defined as an oral temperature ≥38.0 °C (≥100.4 °F) on any 2 of the first 10 days postpartum, excluding the first 24 hours.[46] The first postpartum day is excluded because fevers are common in this period, not associated with increased maternal morbidity, and are typically self-limiting.[46] High temperatures in the postpartum period can be caused by fever or by hyperthermia. In addition to infections, deep vein thrombosis and breast engorgement can also cause fever during the postpartum period. Breast engorgement can be associated with a slight increase in maternal temperature.[47]
No established temperature threshold distinguishes breast engorgement from infectious processes such as mastitis. However, the presence of myalgias and breast erythema strongly favors a diagnosis of mastitis over simple engorgement.[47] Clinicians should remain aware that postpartum patients may also develop infections unrelated to their puerperal status. Routine screening for common infections, including urinary tract infections and pneumonia, can be effectively performed through a careful history and physical examination.
Several noninfectious causes of hyperthermia should be considered during evaluation. These include serotonin syndrome, neuroleptic malignant syndrome, overdoses involving sympathomimetic or anticholinergic agents, withdrawal from ethanol or benzodiazepines, aspirin toxicity, and thyroid storm.[48] Accurate diagnosis of these conditions relies heavily on clinical history and physical findings. Reviewing the patient’s current medications and assessing for recent initiation of serotonergic or neuroleptic agents—often prescribed for postpartum depression or psychosis—can help identify cases of serotonin syndrome or neuroleptic malignant syndrome. Prompt recognition of these potentially life-threatening conditions depends on a systematic and thorough clinical approach.[48]
The hallmark physical examination finding for serotonin syndrome is hyperreflexia and clonus, while for neuroleptic malignant syndrome, lead-pipe rigidity is characteristic.[49] Aspirin toxicity is usually suggested by history; physical examination may show altered mental status, hyperpnea, and abdominal tenderness.[48]
The overdose of sympathomimetic agents presents with tachycardia, hypertension, diaphoresis, and agitation. Withdrawal from benzodiazepines or ethanol can present with tremors, tachycardia, hypertension, and hyperthermia and progress to seizures.[50] Anticholinergic toxicity is characterized by altered mental status, anhidrotic hyperthermia, mydriasis, flushing, and urinary retention.[51] Finally, delivery can precipitate thyroid storm, which presents with hyperthermia, hyperreflexia, nausea, vomiting, and abdominal pain.[52]
Prognosis
Morbidity from postpartum infections affects 5 to 10% of pregnant patients.[53] The prognosis of puerperal infections is directly related to the severity of the infection. Patients who develop sepsis have an estimated mortality of 20%. Mortality for septic shock is approximately 40%.[54]
Complications
All postpartum infections can progress to sepsis, bacteremia, shock, and death if not treated appropriately. Necrotizing fasciitis is especially known for its rapid progression to fulminant infection and death. A notable complication of endometritis and deep space infections of the pelvis is SPT. Endomyometritis affects the endometrium and myometrium but can progress beyond the uterus to include abscess, peritonitis, and pelvic thrombophlebitis.[55] SPT results from intimal pelvic vein injury caused by adjacent uterine infection, bacteremia, or trauma from vaginal or surgical delivery. Infection can also involve the ovarian veins and the inferior vena cava. Risk factors include cesarean section and chorioamnionitis.[56]
Deterrence and Patient Education
Poor access to healthcare is not only a significant risk factor for developing postpartum infections but also a direct factor in treatment delays and associated morbidity and mortality.[57] New parents may delay care secondary to concern that they will be hospitalized away from their baby. Patients with infection following elective abortion may avoid care due to stigma. Postpartum psychiatric conditions and an increase in domestic violence in the peripartum period may likewise inhibit care. Clinicians should strive to create a nonjudgmental environment that allows patients to discuss their concerns and share in decision-making regarding hospitalization and antibiotic choices.
Pearls and Other Issues
Prompt recognition and treatment of postpartum infections are critical to prevent severe complications, eg, sepsis. Pearls include monitoring for fever, uterine tenderness, and foul lochia. Disposition depends on the severity—mild cases may be managed on an outpatient basis, while severe infections require hospitalization and IV antibiotics. Pitfalls include underestimating symptoms or delaying treatment, particularly in patients with risk factors, eg, cesarean delivery or prolonged rupture of membranes. Prevention strategies include timely antibiotic prophylaxis and postpartum education on warning signs. Interprofessional coordination is essential to ensure timely diagnosis, treatment, and follow-up.
Enhancing Healthcare Team Outcomes
Managing postpartum infections demands a high level of clinical awareness, prompt decision-making, and seamless interprofessional collaboration to reduce maternal morbidity and mortality. Physicians and advanced practitioners carry the responsibility of early recognition and accurate diagnosis by integrating clinical history, risk factors, and examination findings. Nurses and midwives contribute essential frontline observations, assist with wound care, monitor for signs of infection, and ensure adherence to care bundles—structured sets of evidence-based practices proven to reduce infection risk, especially after cesarean delivery. Pharmacists play a vital role in optimizing antibiotic selection based on a patient's condition, resistance patterns, and breastfeeding safety considerations. Together, the team must identify modifiable risk factors, such as intrapartum antibiotic timing, hygiene practices, and glycemic control, to help mitigate preventable complications.
Clear and continuous interprofessional communication facilitates the early escalation of care when a postpartum infection is suspected. Shared protocols, huddles, and real-time feedback allow all team members—from bedside nurses to obstetricians—to contribute to risk assessment, treatment planning, and transitions of care. Educating patients on warning signs, hygiene practices, and follow-up instructions also enhances safety and supports autonomy. This activity highlights how collaborative strategies that prioritize timely recognition, team-based intervention, and patient-centered care can substantially improve outcomes, reduce preventable harm, and strengthen team performance across the perinatal continuum.
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