Postpartum Fever – Is it an Emergency?

The development of fever following a delivery is a common complaint in the immediate postpartum period that it is mostly ignored as it resolves without treatment. This is because in the immediate postpartum state, you are still reeling from the pain and stress of delivery and child birth and these can affect the body system of the new mom and so work you up temporarily that you may experience a bout of fever immediately after delivery or within the first 24 hours after delivery. This resolves spontaneously on its own without treatment.

This fever is called benign single-day postpartum fever.

When on the other hand fever develops more than 24 hours after delivery, then it is a cause for concern as it can portend serious events in the immediate aftermath of delivery that it needs to be given urgent attention.

Postpartum fever is therefore defined as the occurrence of an elevated temperature of 38 degrees centigrade on about two occasions at least 4 hours apart in a woman after the first 24 hours of delivery.

Risk factors

The major risk factor for postpartum fever is surgical delivery through cesarean section. Other risk factors attributable to postpartum fever are operative vaginal deliveries, premature rupture of membranes that can result in chorioamnionitis, bacteria vaginosis, obesity, diabetes mellitus, anemia, immunosuppression, multiple unsanitary vaginal examinations and unsanitary vaginal deliveries, prolonged labor, long duration of surgery, passage of urethral catheter in labor.

Causes

The causes can be grouped into what is mnemonically called the 7 Ws of postpartum fever.

This depicts the origin or the source of the causative complaint for the various cases of fever in the postpartum period which your doctor needs to bear in mind and review them from asking you pertinent questions to determine which of them is the real cause of your postpartum fever.

1 Womb

Deals with conditions like postpartum endometritis and chorioamnionitis that affect the uterus and cause infective process within the uterus and its linings.

2 Walk

Associated with deep vein thrombosis, pulmonary embolism and pelvic thrombophlebitis. These are associated with disorders of the clotting system and are exacerbated by immobility occasioned by the delivery process.

3 Water

Urethritis, cystitis and acute pyelonephritis are disorders of the renal and urinary system with infection along the urinary system occasioned by the activities of the delivery process on this system.

4 Wind

Pneumonia and the respiratory tract infections present with fever postpartum which may be related to atelectasis caused by surgical immobility or frank pneumonia presenting on its own

5 Wonder

Drug fever, wonder drugs. Some medications cause fever as a reaction of the drug and can be so severe a reaction to present as an illness on its own term. These may be drugs used during delivery or those given in the immediate postpartum.

6 Wound

Cesarean section wound infection, episiotomy wound infection, perineal abscess. A wound infection is a classical cause of fever any day and the wound infection needs urgent and drastic attention or else it will lead to other co morbitities and complications.

7 Wean

Breast engorgement, breast mastitis, and breast abscess and other nipple and breast feeding problems in the pueperium. These cause fever as a result of the inflammation associated with the engorged breast and its impact especially when it is infected.

Presentation

The presentation of postpartum fever is with fever that occurs past the first day of delivery, the other complaints are related to the cause of the fever which should be discernible by the history you give and the signs elicitable from you. The day of presentation can also act as a pointer to the possible cause as infective conditions take time to set in while conditions like fevers associated with operative vaginal deliveries and chorioamnionitis present early postpartum.

Is it really an emergency?

Fever in the postpartum period is a serious cause for concern as it can herald a serious infection or can be a pointer to a life threatening situation like pulmonary embolism from a deep vein thrombosis. It can also be a prodromal sign of wound infection in someone who has undergone a cesarean birth and a wound infection is not a matter that should be taken lightly after birth especially if you had a cesarean delivery.

Basically postpartum fever should be treated as an emergency and the doctor should be informed immediately fever develops after the first 24hours of delivery so that the cause can be sorted out and prompt treatment given as soon as possible.

Diagnosis

The diagnosis is made from a combination of history presented by you, the signs elicited from your examination by your doctor and some investigations requested which is dependent on the probable cause and can range from a full blood count, blood culture and other specimen cultures and radiological investigations.

Prevention

Postpartum fever can be prevented by eliminating the risk factors that predispose to this condition and ensuring that surgical procedures are conducted as aseptically as possible as infection is a predominant source of postpartum fever.

Treatment

The treatment of postpartum fever is directed to the cause. Your doctor should be able to decide the best treatment for you. The management may be medical with the use of antibiotics and other medications or surgical where this is specifically indicated like an abscess.

Complications

Sepsis –

This can be life threatening. When the infection has gotten into your body system it becomes septicemia and can then go on and affect any of the vital body organs and can lead to multiple organ failure if it is not addressed quickly. It presents with fever that is unremitting, chills and rigors, fast breathing, fast heart rate, sweaty skin, feeling confused and disoriented and can even lead to coma. It needs urgent attention from your healthcare provider.

Abscess –

There may be localized swelling at the site leading to an abscess formation. This will require drainage of the abscess under antibiotics coverage. This is supervised by your healthcare provider for the best outcome.

Final thoughts

Postpartum fever is classed into benign single day fever that occurs within the first 24hours of delivery and are not associated with any infective process and fevers that occur after the 24-hour period that are associated with many causes as documented above.

Fever in the postpartum period is not to be toyed with as it is almost always a harbinger of trouble for the new mom and her baby. It should be addressed quickly and promptly as an emergency to avoid development of complications and bad sequalae.

Dr Mawa

To your postnatal health and freedom

mypostnatalmanagement.com

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