Puerperal Sepsis

Puerperal sepsis is an infection of the genital tract occurring after childbirth or miscarriage. It is a leading cause of maternal death worldwide and requires prompt recognition and treatment.

• Fever, often with chills, within the first days to weeks after delivery
• Lower abdominal or pelvic pain and tenderness
• Foul-smelling or abnormal vaginal discharge (lochia)
• Delayed or poor uterine contraction after delivery
• In severe cases, signs of shock — rapid heart rate, low blood pressure, confusion

• Bacterial infection of the uterus or surrounding genital tract tissues following delivery or miscarriage.
• Risk is increased by prolonged labour, prolonged rupture of membranes before delivery, retained placental tissue, unhygienic delivery conditions, multiple vaginal examinations during labour, and caesarean section.

• Diagnosed clinically based on fever together with uterine tenderness, abnormal vaginal discharge, or delayed involution of the uterus in the days to weeks following childbirth or miscarriage.
• Assessment for retained placental tissue and for signs of spreading infection or shock guides the urgency of treatment.
• Blood tests and, where available, cultures of blood or vaginal discharge can help identify the causative organism and guide antibiotic choice.

Puerperal sepsis is treated as a medical emergency with prompt broad-spectrum intravenous antibiotics, typically a combination covering the range of likely organisms, started as soon as the diagnosis is suspected.

Any retained placental tissue is identified and removed, as it is a common driver of ongoing infection.

Supportive care includes intravenous fluids and monitoring for signs of shock, with urgent escalation of care if the woman deteriorates.

Antibiotics are adjusted based on clinical response and, where available, culture results, and treatment typically continues until the woman is clinically well and fever-free for a sustained period.

• Ensure clean, hygienic delivery practices with a skilled birth attendant.
• Ensure prompt and complete delivery of the placenta, with careful checking that it is complete.
• Minimise unnecessary vaginal examinations during labour.
• Seek prompt medical care for fever, abnormal vaginal discharge, or abdominal pain in the days or weeks following childbirth or miscarriage.