Postpartum Infection: Types, Causes, Symptoms & Treatment

Instructor: Courtney Dohse
In this lesson, we will learn about various types of postpartum infections, including causes, signs, and symptoms that may be present, as well as methods of treatment for each infection.

Case Study

Amy is a 30-year-old first time mother who is four days postpartum. She had an uncomplicated vaginal birth and delivered a baby girl who she is now breastfeeding. She was just discharged from the hospital a couple days before, and since she has been home, has been feeling pain in her right breast accompanied by a fever of 102.3 degrees and flu-like symptoms. Upon inspection of her breasts, she notices red streak-like marks only on the right side. She calls her obstetrician and explains her symptoms.

Types of Postpartum Infections

Although uncommon, there are a few different infections that are prevalent among postpartum women. A postpartum infection is an infection that occurs within 10 days of a woman delivering her baby. Most postpartum infections are diagnosed within the first 24 hours after delivery, but some women may not show symptoms this quickly and will, therefore, be diagnosed later. Let's take a look at a few of the most common infections occurring in postpartum women.

Mastitis

In our case study, Amy is a breastfeeding mother complaining of unilateral breast pain accompanied by fever and flu-like symptoms. After calling her provider, she is diagnosed with mastitis. Mastitis is an infection of the breast tissue that most commonly affects women who are breastfeeding. It affects 1 in 10 nursing mothers. Fever and flu-like symptoms are common, but sometimes mastitis can occur without visible signs to the breast (such as redness or swelling). Mastitis is usually caused by cracked or excoriated nipples, but may also be a result of over-production of breast milk in the mother. If the mother has an oversupply problem, this often leads to milk becoming stagnant in the milk ducts. This can cause a clogged milk duct, which if left untreated, can quickly turn into mastitis.

The best treatment of mastitis is of course prevention. It is important for the mother to empty her breasts as much as possible with each feeding. If the baby does not nurse well, it is important for her to use a breast pump to 'pump off' any milk to keep production moving and prevent milk from becoming stagnant in the milk ducts. Using a topical cream, such as Lanolin, after each feeding may help prevent cracked nipples which are a gateway for infection into the breast. If prevention efforts fail, and a woman develops mastitis, the method of treatment is usually a 10-day course of oral antibiotics, such as amoxicillin.

Treatment and prevention of mastitis are very important to encourage mothers to continue their breastfeeding journeys. It is imperative for them to know that nursing with mastitis is not contraindicated, but rather suggested. It will help the mother's infection to resolve and it will not pass from the mother to the baby.

Endometritis

Endometritis is an infection of the uterine lining that becomes more common after childbirth. All women have a normal mix of bacteria in the birth canal, but some women carry a bacterium called Group Beta Strep. If a woman naturally carries this bacterium, it is usually harmless to her. However, during a prolonged labor, if this bacterium multiplies and becomes out of control, it may lead to an infection of the uterus. Another possible cause would be a birth that was assisted with medical instruments such as forceps or a vacuum extractor. Women with a history of sexually transmitted diseases and infections are also at a greater risk for developing endometritis. Women who may have had a piece of the placenta retained in the uterus after delivery are also at a greater risk for developing this infection.

A patient with endometritis may exhibit the following symptoms: abdominal swelling, heavy vaginal bleeding, fever and flu-like symptoms. Treatment of endometritis should not be delayed because it can have long term effects on the reproductive organs and fertility. The treatment for this infection includes swabbing the birth canal to identify the strain of bacteria present, followed by a course of antibiotics. Many times if the woman is still inpatient, intravenous antibiotics will be given while she is there since they tend to work better and faster.

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