Postpartum Infections

• Postpartum endometritis: inflammation of the uterine lining caused by bacterial infection that ascends from the vagina or cervix during labor or delivery. It is more common after cesarean section, instrumental delivery, prolonged rupture of membranes, prolonged labor, multiple vaginal examinations, retained placenta, or manual removal of placenta.

• Clinical features: fever (higher than 38°C for more than 48 hours), abdominal or pelvic pain, foul-smelling or purulent vaginal discharge, uterus enlarged, soft, painful when mobilized; open cervix; swelling in the posterior fornix

• Management: admit to inpatient department; administer antibiotherapy such as amoxicillin/clavulanic acid IV plus gentamicin IM or ampicillin IV plus metronidazole IV plus gentamicin IM; continue treatment 48 hours after resolution of fever and other signs; look for retained placenta and perform uterine evacuation after 24 to 48 hours of antibiotherapy; if haemodynamically unstable due to hemorrhage or infection, perform uterine evacuation immediately

Pelvic abscess or peritonitis: complication of untreated puerperal endometritis/salpingitis; involves collection of pus in the pelvic cavity or inflammation of the peritoneum

• Clinical features: abdominal guarding or spasm, ileus, pelvic mass

• Management: laparotomy or colpotomy to drain the abscess; same antibiotherapy as for postpartum endometritis and salpingitis

• Wound infection: infection of the surgical site (cesarean section) or episiotomy/laceration repair

• Clinical features: fever, redness, swelling, pain, purulent drainage, dehiscence or separation of wound edges

• Management: clean wound with sterile saline; apply sterile dressing; culture wound if indicated; administer antibiotics as prescribed; monitor wound healing; teach wound care.

Mastitis: inflammation of the breast tissue caused by bacterial infection that enters through cracked nipples; usually affects one breast; more common in lactating women

• Clinical features: fever, chills, malaise, headache, breast pain, tenderness, redness, swelling, hardness or induration of affected area

• Management: continue breastfeeding or pumping from both breasts; apply warm compresses before feeding; massage affected area gently during feeding; vary breastfeeding positions; ensure proper latch-on technique; wear supportive bra; avoid tight clothing; change breast pads frequently; maintain good hygiene; drink plenty of fluids; rest; take analgesics as prescribed; take antibiotics as prescribed

Breast abscess: complication of untreated mastitis; involves collection of pus in the breast tissue

• Clinical features: fever, chills, malaise, headache, breast pain, tenderness, redness, swelling, hardness or induration of affected area; fluctuant mass; purulent drainage or fistula formation

• Management: incision and drainage of abscess under local anesthesia; culture pus if indicated; apply sterile dressing; change dressing daily; administer antibiotics as prescribed; continue breastfeeding or pumping from unaffected breast; express milk manually from affected breast until healed