Post-Partum Pyrexia

Introduction

Post-partum pyrexia refers to body temperature of 38°C or more on 2 or more occasions during the first 10 days of the puerperium excluding the first day.
Risk Factors include prolonged labour, prolonged premature rupture of membranes, retained placental tissue, instrumental deliveries and birth canal injuries.

Causes of post-partum pyrexia

The following conditions are the causes of post-partum pyrexia:

  1. Malaria
  2. Uterine infection (endo-myometritis)
  3. Perineal Infections (e.g. infected episiotomy)
  4. Breast problems (engorgement, mastitis, abscess formation)
  5. Urinary tract infection
  6. Respiratory tract infection

Symptoms of post-partum pyrexia

The symptoms of post-partum pyrexia include the following:

  1. Fever
  2. Other symptoms as related to cause

Signs of post-partum pyrexia

  • Fever
  • Other signs as related to cause

Investigations

  • FBC
  • RDT
  • Blood film for malaria parasites
  • Blood for culture and sensitivity
  • Urine for culture and sensitivity
  • High vaginal swab
  • Fasting or Random Blood Glucose
  • Pelvic scan to exclude retained products of conception or pelvic abscess

Treatment

Treatment objective

The treatment objective of post-partum pyrexia is:

  • To identify and treat the underlying cause

Non-pharmacological treatment

  • Examination under anaesthesia with possible uterine curettage for retained products of conception
  • Encourage frequent emptying of breasts if cause is due to engorgement
  • Incision and drainage for breast and perianal abscess

Pharmacological treatment

A. Breast problems – engorgement

Evidence Rating: [B]
Paracetamol, oral,

  • 1 g 6-8 hourly as required for 7 days

B. Breast problems – mastitis/abscess

Evidence Rating: [A]
Flucloxacillin, oral,

  • 500 mg 6 hourly for 5-7 days

C. Endo-myometritis and perineal infections

Evidence Rating: [B]
Amoxicillin + Clavulanic Acid, IV,

  • 600 mg-1.2 g 8 hourly for 72 hours

And

Metronidazole, IV,

  • 500 mg 8 hourly for 72 hours

Then

Amoxicillin + Clavulanic Acid, oral,

  • 625 mg-1 g 12 hourly

And

Metronidazole, oral,

  • 400 mg 8 hourly for 7 days

Referral Criteria

Refer all cases of postpartum pyrexia to hospital for management.