Doctors Revision

Obstetrics

Puerperal Sepsis / Fever

Infection of the genital tract occurring any time between the onset of rupture of membranes or labour, and the 42nd day postpartum (puerperium), characterized by fever and signs of pelvic infection.

Also known as: Postpartum Infection, Childbed Fever

Open in the interactive guide
On this page

Referral and warning signs

When to refer

Refer ALL suspected cases to hospital (HC4/H/RR) for IV antibiotics. Urgent transfer if shock/severe sepsis.

Red flags

  • High fever / Hypothermia
  • Signs of shock
  • Severe abdominal pain / Peritonism
  • Profuse purulent/foul lochia
  • Respiratory distress
  • Oliguria

Signs and symptoms

  • Fever (>38°C) developing >24 hours postpartum.
  • Chills, malaise.
  • Lower abdominal pain.
  • Uterine tenderness / Subinvolution.
  • Foul-smelling or purulent lochia.
  • Signs of severe sepsis/shock.

Risk factors

  • Prolonged labour/ROM.
  • Multiple VEs.
  • MRP.
  • Retained POC.
  • Operative delivery/C-S.
  • Tears/Episiotomy.
  • Anaemia/Malnutrition.
  • Poor hygiene.
  • Untreated infections.
  • HIV.

Diagnosis

Clinical assessment

Fever >24h postpartum PLUS >=1 of: pelvic pain, abnormal discharge, uterine tenderness, delayed involution. Rule out UTI, Malaria, Mastitis, Wound infection, DVT/PE.

Investigations

  • FBC (Leucocytosis).
  • HVS/Endocervical Swab for C&S.
  • Blood Cultures (if sepsis).
  • Urinalysis & Culture.
  • Malaria Test.
  • CXR (if resp symptoms).
  • Pelvic Ultrasound (retained POC/abscess).

Diagnostic criteria

Clinical diagnosis: Fever + signs of genital tract infection postpartum.

Management

Non-pharmacological management

  • Hospital admission.
  • Bed rest (Fowler's position).
  • Monitor vital signs.
  • Hydration (oral/IV).
  • Remove retained POC (after starting antibiotics).

Pharmacological treatment

  • Broad-Spectrum IV Antibiotics: Ampicillin IV + Gentamicin IV + Metronidazole IV. Alternative: Clindamycin + Gentamicin. Continue IV until afebrile 48h, then switch to oral to complete 7-10d course.
  • Analgesia/Antipyretics: Paracetamol.
  • Supportive Care.
  • Consider Heparin (septic thrombophlebitis - specialist).

Monitoring

Monitor vitals, pain, tenderness, lochia. Monitor FBC/renal function if severe.

Complications

  • Septic shock.
  • Pelvic abscess.
  • Septic pelvic thrombophlebitis.
  • Peritonitis.
  • Wound dehiscence.
  • Infertility.
  • Chronic pelvic pain.
  • Death.

Prevention

  • Good hygiene.
  • Aseptic techniques.
  • Minimize VEs.
  • Manage prolonged labour/ROM.
  • Complete placental removal.
  • Prophylactic antibiotics when indicated.

Patient education

  • Explanation of infection.
  • Need for admission/IV antibiotics.
  • Complete full course.
  • Hygiene.
  • Signs of worsening.
  • Follow-up.
  • Family planning.

Uganda-specific notes

Major cause of maternal mortality. Often linked to home delivery/delays. Prompt broad-spectrum IV antibiotics (Amp/Gent/Metro) critical.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 16, Section 16.4.7

Scroll to Top