Chapter 220 Puerperal Infection
INTRODUCTION
Description: Although the term puerperal infection can be used to describe any infection during or after labor, it generally applies to infection of the uterus and surrounding tissues after delivery. (See also Chorioamnionitis.) This can vary from mild to life-threatening in severity. Some of the most severe infections may appear within hours of delivery and are often opportunistic and not associated with reliable risk factors. Vigilance and aggressive diagnosis and treatment are required.
Prevalence: Estimated to occur in 1% to 8% of vaginal deliveries; approximately 15% if chorioamnionitis is present during labor. Following cesarean delivery: 10% to 20% if antibiotic prophylaxis is given during delivery, 50% to 90% without antibiotic prophylaxis in some series.
ETIOLOGY AND PATHOGENESIS
Causes: Colonization and infection of the tissues of the uterus, peritoneum, or surrounding organs. The most common organisms are group B streptococci; other facultative streptococci; Gardnerella vaginalis; and Escherichia coli, Bacteroides, and Peptostreptococcus species. Infection by clostridia or group A streptococci may result in rapidly progressive soft-tissue (subcutaneous tissue, muscle, or myometrial) infection. Abscesses usually contain both aerobic and anaerobic bacteria such as Bacteroides species (Bacteroides bivius, Bacteroides disiens, or Bacteroides fragilis). Approximately 50% of ascending uterine infections involve Chlamydia trachomatis.
Risk Factors: Cesarean delivery (10- to 20-fold increase), invasive procedures during labor, prolonged rupture of the membranes, prolonged labor, multiple examinations, retained placental fragments, urinary catheter, intravenous line(s), low socioeconomic or nutritional status, anemia, and chronic disease (diabetes).
