Postpartum Sepsis

Postpartum sepsis is a severe bodily reaction to an infection that occurs within 6 weeks after giving birth (postpartum). The condition is also called puerperal sepsis. Pregnancy causes changes in your body’s disease-fighting system (immune system) that increase your risk for infection and sepsis.

Postpartum sepsis is a medical emergency that needs to be treated right away. It can cause inflammation, leaking blood vessels, and decreased blood flow to important organs, including your lungs, liver, and kidneys. If sepsis is not diagnosed and treated quickly, it can lead to septic shock. Shock can result in dangerously low blood pressure and organ failure.

What are the causes?

This condition is caused by a severe immune system reaction to an infection. A type of bacteria called group A streptococcus is the most common cause of infection that leads to postpartum sepsis. Other types of bacteria can also lead to postpartum sepsis.

Infections that lead to postpartum sepsis can be directly related to birth or can develop during the postpartum period. Common examples include:

• Wound infection from a cesarean delivery.
• Uterus infection (endometritis).
• Genital tract infection of the vagina or cervix.
• Breast infection (mastitis).
• Urinary tract infection.
• Pneumonia.
• Blood vessel infection (phlebitis).
• Skin infection (cellulitis).

What increases the risk?

You are more likely to develop this condition if you have any of these pregnancy-related risk factors:

• Cesarean delivery.
• Episiotomy.
• Long or difficult labor.
• Internal fetal monitoring.
• Rupture of membranes many hours before giving birth.

You may also be at higher risk if you have any of these conditions during or after giving birth:

• Congestive heart failure.
• Long-term liver disease.
• Long-term kidney disease.
• An active infection.
• Systemic lupus erythematosus (lupus).
• Diabetes.
• Obesity.

What are the signs or symptoms?

Early symptoms of this condition may be the symptoms of infection and will depend on the area that is infected. Common symptoms include:

• Fever.
• Chills.
• Painful or frequent urination.
• Redness or drainage from a surgical incision.
• Cough or chest pain.
• Abdominal or pelvic pain.
• A swollen or painful breast.
• Warm, red skin.
• Drainage or foul-smelling vaginal discharge.

As the infection progresses to sepsis, these symptoms may develop:

• High fever.
• Shivering or feeling very cold.
• Weakness.
• Dizziness.
• Confusion.
• Severe pain.
• Rapid breathing.
• Shortness of breath.
• Racing pulse.
• Cold and clammy or discolored skin.
• Decreased urine output.
• Anxiety.

Postpartum sepsis may develop any time within 6 weeks of giving birth, but it usually occurs within a few days of giving birth.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and your medical history, including any risk factors for the condition.
• A physical exam.
• Tests to find the source of infection. These may include:
  • Cultures of blood, wound drainage, urine, or vaginal discharge.
  • Blood tests to check for:
    • Liver or kidney damage.
    • Signs of infection or blood mineral (electrolyte) imbalance.
    • Signs of septic shock.
  • Imaging studies, such as X-rays, ultrasound, CT scan, and MRI. These are done to look for infection, tissue damage, or a collection of pus (abscess).

How is this treated?

This condition is treated in the hospital as a medical emergency. The goal of treatment is to control the infection, support breathing and blood pressure, and prevent septic shock. Treatment may include:

• Fluids given through an IV.
• Antibiotic medicines given through an IV.
• Breathing support. This may include giving oxygen or placing a tube into the trachea (endotracheal tube).
• IV medicine to support blood pressure.
• Kidney dialysis. This process filters the blood if kidney failure occurs.
• Surgery to drain an abscess or remove dead or dying tissue.

Follow these instructions at home:

• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Drink enough fluid to keep your urine pale yellow.
• Eat a healthy, balanced diet. This includes plenty of fruits and vegetables, whole grains, low-fat (lean) proteins, and low-fat dairy. Ask your health care provider if you should avoid certain foods.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or fever.
• You have a cough or shortness of breath.
• You have frequent or painful urination.
• You have new or foul smelling vaginal discharge.
• You have any area that becomes red, swollen, or painful.
• You have any other symptoms of infection.

Get help right away if:

• You have high fever or shivering.
• You have severe pain.
• Your skin becomes pale, clammy, or discolored.
• You feel confused or very sleepy.
• You have chest pain or difficulty breathing.

Summary

• Postpartum sepsis is a severe bodily reaction to an infection that occurs within 6 weeks after giving birth.
• Pregnancy causes changes in your immune system that increase your risk for infection and sepsis.
• This is a very serious condition that is treated in the hospital as a medical emergency.
• Treatment may include IV fluids, IV antibiotics, breathing support, and surgery.