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:
- Malaria
- Uterine infection (endo-myometritis)
- Perineal Infections (e.g. infected episiotomy)
- Breast problems (engorgement, mastitis, abscess formation)
- Urinary tract infection
- Respiratory tract infection
Symptoms of post-partum pyrexia
The symptoms of post-partum pyrexia include the following:
- Fever
- 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.