Postpartum Infection

Postpartum (puerperal) infection is infection of the genital tract or related structures after childbirth, historically known as childbed fever. Once a leading cause of maternal death, it remains an important and potentially serious complication of the puerperium worldwide. The most common form is postpartum endometritis, but infection can also involve the surgical or perineal wound, the urinary tract, and the breast, and can progress to maternal sepsis.

Definition

Postpartum (puerperal) infection is a bacterial infection of the genital tract or associated structures occurring after delivery, classically presenting as fever in the puerperium and most commonly arising as endometritis; severe forms progress to puerperal sepsis.

Scope

This topic covers the concept, common forms, mechanisms, and burden of postpartum infection — endometritis, wound and perineal infection, urinary and breast infection, and progression to puerperal sepsis — and the historical significance of puerperal fever. It is a reference-educational overview of the clinical entity; it does not provide diagnostic criteria for an individual or any antibiotic or treatment instructions.

Core questions

• What are the common forms of postpartum infection and where do they arise?
• What organisms and routes underlie puerperal infection?
• What risk factors increase the likelihood of postpartum infection?
• How is puerperal infection recognised, and when does it become sepsis?
• Why has postpartum infection been historically and globally important?

Key concepts

• Puerperal endometritis
• Surgical-site and perineal wound infection
• Puerperal sepsis
• Ascending polymicrobial infection
• Group A and group B streptococcus
• Risk factors (caesarean delivery, prolonged rupture of membranes)
• Puerperal fever (historical)
• Maternal sepsis

Mechanisms

Most postpartum genital-tract infections are ascending and polymicrobial, arising when organisms from the vaginal and bowel flora colonise the raw placental implantation site, the endometrium, or surgical and perineal wounds after delivery. Endometritis is the prototypical form. Risk is increased by caesarean delivery, prolonged labour or rupture of membranes, and operative or instrumented delivery. Certain organisms — notably group A streptococcus — can cause rapidly progressive, severe disease. If localised infection is not controlled, the systemic inflammatory response can progress to maternal sepsis, with organ dysfunction and risk of death.

Clinical relevance

Postpartum infection is an important cause of maternal morbidity and a recognised contributor to maternal mortality, particularly where access to clean delivery, surveillance, and treatment is limited. Awareness of its forms, risk factors, and the fact that fever in the puerperium can herald serious infection supports timely recognition and escalation. This entry describes the clinical entity for reference and education; it is not a basis for diagnosing or treating an individual, which requires direct clinical assessment.

Epidemiology

Globally, sepsis and infection are among the leading direct causes of maternal death, accounting for a notable share of maternal mortality alongside haemorrhage and hypertensive disorders, with the heaviest burden in low-resource settings. Wound and genital-tract infection rates are higher after caesarean than vaginal birth, and the overall contribution of infection to maternal death has fallen historically in settings with asepsis, antibiotics, and surveillance.

History

Puerperal or childbed fever was a major cause of maternal death in lying-in hospitals before the germ theory of disease. In the 1840s Ignaz Semmelweis showed that hand antisepsis dramatically reduced puerperal mortality, and Oliver Wendell Holmes independently argued for its contagious spread; these observations, later vindicated by bacteriology, made puerperal infection a landmark in the history of infection control. The subsequent advent of antibiotics further reduced its lethality.

Key figures

• Ignaz Semmelweis
• Oliver Wendell Holmes

Seminal works

• say-2014
• kassebaum-2016

Frequently asked questions

What is the most common form of postpartum infection?

Postpartum endometritis — infection of the lining of the uterus — is the most common form, typically arising from an ascending, polymicrobial infection after delivery, and is more frequent after caesarean birth.

Why is postpartum infection historically significant?

As childbed fever it was once a leading cause of maternal death; the demonstration by Semmelweis that hand antisepsis sharply reduced mortality was a foundational step in infection control and the eventual acceptance of germ theory.