Coupon Accepted Successfully!


Puerperal Pyrexia

A rise in temperature reaching 100.4°P (38°C) or more (measured orally) on two separate occasions at 24 h apart (excluding the first 24 h) within the first 10 days following delivery is called puerperal pyrexia.


  1. Puerperal sepsis
  2. Acute pyelonephritis
  3. Breast engorgement
  4. Wound infection
  5. Thrombophlebitis
  6. Atelectasis and pneumonia

Puerperal Sepsis

  1. An infection of the genital tract which occurs as a complication of delivery is called puerperal sepsis.
  2. Postpartum uterine infection has been called variously endometritis, endomyometritis, and endoparametritis.
  3. Because infection actually involves not only the decidua but also the myometrium and parametrial tissues, the preferred term is metritis with pelvic cellulitis.
  4. The route of delivery is the single most significant risk factor for the development of uterine infection.
  5. Compared with cesarean delivery, metritis following vaginal delivery is relatively uncommon.
  6. Most female pelvic infections are caused by bacteria indigenous to the female genital tract.

Predisposing Factors of Puerperal Sepsis



1. Malnutrition

1. Multiple cervical examinations

2. Anemia

2. Internal fetal monitoring

3. Preeclampsia

3. Chorioamnionitis


4. Retained placenta

5. Immunocompromised status (HJV)

5. PPH

6. Diabetes mellitus

6. Prolonged labor

7. Obesity

7. Operative delivery (LSCS)



Bacteria Commonly Responsible for Female Genital Infections


  1. Group A, B, D streptococci
  2. Enterococcus
  3. Gram-negative bacteria-Escherichia coli, Klebsiella, and Proteus species
  4. Staphylococcus aureus
  5. Gardnerella vaginalis


  1. Peptococcus species
  2. Peptostreptococcus species
  3. Bacteroides species
  4. Clostridium species
  5. Fusobacterium species
  6. Mobiluncus species


  1. Mycoplasma species
  2. Chlamydia trachoma
  3. Neisseria gonorrheae
  4. Fever is the most important criterion for the diagnosis of postpartum metritis. Temperature commonly exceeds 38-39°C. Chills may accompany fever and suggest bacteremia, which is documented in 10-20% of women with pelvic infection following cesarean delivery.
  5. Women have foul-smelling lochia without evidence for infection. Other infections, notably those due to group A β-hemolytic streptococci, are frequently associated with scanty, odorless lochia.
  6. Leukocytosis may range from 15,000 to 30,000 cells/μL.
  7. Complications of metritis that cause persistent fever despite appropriate therapy include a parametrial phlegmon or an area of intense cellulitis, a surgical incisional or pelvic abscess, and infected hematoma, and septic pelvic thrombophlebitis.

Antimicrobial Regimens for Pelvic Infection Following Cesarean Delivery




Clindamycin 900 mg + gentamicin

1.5 mg/kg, q8h intravenously

Plus ampicillin

Clindamycin + aztreonam

Extended-spectrum penicillins

Imipenem + cilastatin

"Gold standard," 90-97% efficacy, once-daily gentamicin dosing


Added to regimen with sepsis syndrome or suspected enterococcal infection

Gentamicin substitute with renal insufficiency

Piperacillin, ampicillin/ sulbactam

Reserved for special indications

Test Your Skills Now!
Take a Quiz now
Reviewer Name