Postpartum Infection

Marina Boushra, Omar Rahman, Marina Boushra, Omar Rahman

Excerpt

Maternal morbidity and mortality are global socioeconomic and healthcare burdens, and postpartum infections account for a significant, and often preventable, portion of that burden. The postpartum period is traditionally defined as the six weeks following delivery, and infections are relatively common, affecting an estimated 5 to 7% of women during this time. Puerperal sepsis is one of the top five causes of maternal deaths worldwide and accounts for 10 to 15% of deaths in the postpartum period. Infections are also the most common cause of death following spontaneous or induced abortions. The medical burden of these infections is compounded by the alarmingly rapid increase in bacterial resistance to commonly used antibiotics.

Postpartum infections also present a significant social burden: they increase maternal anxiety and the risk of postpartum depression, interfere with bonding, and negatively impact breastfeeding. Postpregnancy infections discussed in this review include infections that occur after live births, stillbirths, and spontaneous or induced abortion. Mastitis is not included in this discussion, as it does not directly result from pregnancy or delivery.

Copyright © 2023, StatPearls Publishing LLC.

References

    1. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18.
    1. Belfort MA, Clark SL, Saade GR, Kleja K, Dildy GA, Van Veen TR, Akhigbe E, Frye DR, Meyers JA, Kofford S. Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. Am J Obstet Gynecol. 2010 Jan;202(1):35.e1-7.
    1. Groer MW, Morgan K. Immune, health and endocrine characteristics of depressed postpartum mothers. Psychoneuroendocrinology. 2007 Feb;32(2):133-9.
    1. Creanga AA. Maternal Mortality in the United States: A Review of Contemporary Data and Their Limitations. Clin Obstet Gynecol. 2018 Jun;61(2):296-306.
    1. Tharpe N. Postpregnancy genital tract and wound infections. J Midwifery Womens Health. 2008 May-Jun;53(3):236-246.
    1. Yokoe DS, Christiansen CL, Johnson R, Sands KE, Livingston J, Shtatland ES, Platt R. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis. 2001 Sep-Oct;7(5):837-41.
    1. Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, Syverson CJ. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ. 2003 Feb 21;52(2):1-8.
    1. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM, Barfield W. Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2019 Sep 06;68(35):762-765.
    1. Allen VM, O'Connell CM, Liston RM, Baskett TF. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol. 2003 Sep;102(3):477-82.
    1. Newton ER, Prihoda TJ, Gibbs RS. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet Gynecol. 1990 Mar;75(3 Pt 1):402-6.
    1. Eschenbach DA. Treating spontaneous and induced septic abortions. Obstet Gynecol. 2015 May;125(5):1042-1048.
    1. Ahman E, Shah IH. New estimates and trends regarding unsafe abortion mortality. Int J Gynaecol Obstet. 2011 Nov;115(2):121-6.
    1. Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol. 2008 Jun;29(6):477-84; discussion 485-6.
    1. Allen-Bridson K, Gross C, Hebden JN, Morrell GC, Wright MO, Horan T. Healthcare-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration-Ventilator-associated event 1, 2013. Am J Infect Control. 2013 Nov;41(11):1085-6.
    1. Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Health Neonatol Perinatol. 2017;3:12.
    1. Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol. 2000;8(2):77-82.
    1. Roberts S, Maccato M, Faro S, Pinell P. The microbiology of post-cesarean wound morbidity. Obstet Gynecol. 1993 Mar;81(3):383-6.
    1. Fontes RA, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg. 2000 May-Jun;8(3):151-8.
    1. Barant S, Radbata D, Oberweis D, Jacobs D, Marecaux G, Zielonka E, Maréchal M. [Abdominal necrotizing fasciitis after caesarean delivery]. Rev Med Brux. 2016;37(3):178-182.
    1. Almarzouqi F, Grieb G, Klink C, Bauerschlag D, Fuchs PC, Alharbi Z, Vasku M, Pallua N. Fatal Necrotizing Fasciitis following Episiotomy. Case Rep Surg. 2015;2015:562810.
    1. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol. 2018 Jun;131(6):e172-e189.
    1. Dalton E, Castillo E. Post partum infections: A review for the non-OBGYN. Obstet Med. 2014 Sep;7(3):98-102.
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.
    1. Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ. Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review. Obstet Gynecol. 2015 Apr;125(4):789-800.
    1. Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015 Feb 02;2015(2):CD001067.
    1. Udoh A, Effa EE, Oduwole O, Okusanya BO, Okafo O. Antibiotics for treating septic abortion. Cochrane Database Syst Rev. 2016 Jul 01;7(7):CD011528.
    1. Savaris RF, de Moraes GS, Cristovam RA, Braun RD. Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study. Am J Obstet Gynecol. 2011 Apr;204(4):301.e1-5.
    1. Fitzwater JL, Tita AT. Prevention and management of cesarean wound infection. Obstet Gynecol Clin North Am. 2014 Dec;41(4):671-89.
    1. Kamath RS, Sudhakar D, Gardner JG, Hemmige V, Safar H, Musher DM. Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department. Open Forum Infect Dis. 2018 Jan;5(1):ofx188.
    1. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014 Jul 15;59(2):147-59.
    1. Haeri S, Baker AM. Estimating risk factors and causes for postpartum febrile morbidity in teenage mothers. J Obstet Gynaecol. 2013 Feb;33(2):149-51.
    1. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008 Sep 15;78(6):727-31.
    1. Boushra MN, Miller SN, Koyfman A, Long B. Consideration of Occult Infection and Sepsis Mimics in the Sick Patient Without an Apparent Infectious Source. J Emerg Med. 2019 Jan;56(1):36-45.
    1. Simon LV, Hashmi MF, Callahan AL. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2023. Feb 19, Neuroleptic Malignant Syndrome.
    1. Wolf C, Curry A, Nacht J, Simpson SA. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open Access Emerg Med. 2020;12:53-65.
    1. Robinson D, Araklitis G. Anticholinergic therapy: A case-based approach. Case Rep Womens Health. 2020 Jan;25:e00164.
    1. Keyal NK, Pokharel N, Khanal S. Thyroid storm presenting as septic shock in the intensive care unit: A Case Series. JNMA J Nepal Med Assoc. 2020 Jan;58(221):48-51.
    1. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010 Jun;23(3):249-54.
    1. Burdick H, Pino E, Gabel-Comeau D, McCoy A, Gu C, Roberts J, Le S, Slote J, Pellegrini E, Green-Saxena A, Hoffman J, Das R. Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: a prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Health Care Inform. 2020 Apr;27(1)
    1. Faure K, Dessein R, Vanderstichele S, Subtil D. [Postpartum endometritis: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. Gynecol Obstet Fertil Senol. 2019 May;47(5):442-450.
    1. DeNoble AE, Heine RP, Dotters-Katz SK. Chorioamnionitis and Infectious Complications after Vaginal Delivery. Am J Perinatol. 2019 Dec;36(14):1437-1441.
    1. McKinley LP, Wen T, Gyamfi-Bannerman C, Wright JD, Goffman D, Sheen JJ, D'Alton ME, Friedman AM. Hospital Safety-Net Burden and Risk for Readmissions and Severe Maternal Morbidity. Am J Perinatol. 2021 Aug;38(S 01):e359-e366.
    1. Kawakita T, Umans JG. Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections? Am J Perinatol. 2019 Nov;36(13):1325-1331.
    1. Shea SK, Soper DE. Prevention of Cesarean Delivery Surgical Site Infections. Obstet Gynecol Surv. 2019 Feb;74(2):99-110.
    1. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 01;152(8):784-791.
    1. Al-Niaimi AN, Ahmed M, Burish N, Chackmakchy SA, Seo S, Rose S, Hartenbach E, Kushner DM, Safdar N, Rice L, Connor J. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients. Gynecol Oncol. 2015 Jan;136(1):71-6.
    1. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol. 2018 Sep;132(3):e103-e119.
    1. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 74. Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2006 Jul;108(1):225-34.
    1. ACOG Practice Bulletin No. 199 Summary: Use of Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol. 2018 Sep;132(3):798-800.
    1. Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis. 2002 Oct 15;35(8):950-9.

Source: PubMed

3
Předplatit