What Causes Postpartum Fever, Treatment And When To Worry

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Postpartum fever is when a mother has an oral temperature of more than 38°C (100.4°F) during the first 24 hours after delivery. It is a common obstetric problem that usually occurs due to underlying gynecological complications, such as surgical wound infection, endometritis, or urinary tract infection (1).

Timely diagnosis and treatment of the cause can avert complications and help relieve postpartum fever. Read this post to know more about the causes, treatments, and effective prevention strategies for postpartum fever.

Is Postpartum Fever Normal?

Postpartum fever is often common in women who undergo C-section deliveries since they are usually more prone to infections. Fever and infections may also usually be more common in women who undergo labor before a C-section delivery (2). You may also experience soreness, headaches, and body aches after childbirth. In most cases, the postpartum fever is manageable. However, if you experience a fever higher than 38°C (100.4°F), you must consult your doctor.

What Causes Postpartum Fever?

Postpartum fever is usually reported in women within 24 hours after delivery. A fever after delivery might be related to fluid loss, sudden hormonal changes, and several other reasons. The following conditions and risk factors may lead to postpartum fever.

1. Infection after C-section

C-sections, like other surgeries, pose the risk of complications such as wound infection, endometrial infection (infection in womb lining), excessive bleeding, and blood clots (3). Postoperative complications include wound hematoma, rashes combined with a discharge, and polymicrobial infections such as necrotizing fasciitis (4). These infections manifest in the form of a fever, redness, and pain in the infected site. Nevertheless, women who undergo C-sections are administered antibiotic doses before surgery to reduce the risk of infections.

2. Endometritis

Postpartum endometritis is an infection of the endometrium, myometrium, and surrounding tissues within the uterus. Fever is the first sign of this infection, along with other symptoms such as bleeding, tenderness in the uterine area, lower abdominal pain, and foul-smelling vaginal discharge (5). The infection often occurs in women who undergo C-sections.

3. Mastitis

Mastitis is the inflammation in the breast often due to bacterial infection. Mastitis occurs after childbirth, especially when the new mother starts breastfeeding and develops a crack or soreness in the nipple area. The condition often manifests as a fever (5). The other signs of this condition include chills, pain in the breast region, body aches, skin redness, and swelling in and around the breast (6).

4. Urinary tract infection

Women who undergo a C-section are at a higher risk of developing a urinary tract infection (UTI) than women who have a vaginal delivery (7). Other risk factors for UTI in women after delivery include preeclampsia, a history of renal disease, tocolysis, bladder sensitivity, and placental abruption (8). The common symptoms of postpartum UTI are malaise, high fever, pain or burning sensation while urinating, lower abdominal pain, and tenderness in the pelvis.

5. Other causes

Several other infections related or unrelated to childbirth may lead to fever. A few common ones include pneumonia, skin and soft tissue infections, gastroenteritis, infection due to anesthesia, sepsis, perineal wound infection, malaria, typhoid, acute appendicitis, herpes simplex virus infection, and vaginal infections (9) (10).

What Are The Treatment Options For Postpartum Fever?

The treatment for postpartum fever depends on its duration, causal agent of infection or fever, and the severity of the condition. Mild postpartum fever resolves without treatment. However, fever that doesn’t seem to go away or keeps increasing must be treated.

The first line of treatment is by oral antibiotic therapy, with a specific treatment regimen for any postpartum infection. The antibiotics ampicillin, clindamycin, and gentamicin are commonly prescribed (11). Additional medications may be considered if the woman does not respond to antibiotic therapy (1).

How To Prevent Postpartum Fever?

The most common causes of postpartum fever are infections and various conditions of inflammatory nature. Hence the rate of occurrence of fever could be reduced by preventing infections. Certain preventive measures may be useful in reducing the risk of postpartum infections, fever, and complications (2) (11) (12).

  • Pre-delivery and routine screening to check and detect maternal fever or infection risk.
  • Adhering to frequent handwashing throughout the day, especially before and after using the toilet.
  • Assuring aseptic environments in hospitals and healthcare setups to minimize the risk of maternal infections.
  • Maintaining sterile environments all the time and limiting room traffic in a new mother’s room.
  • Regular monitoring of vitals, such as pulse and blood pressure, to detect any anomaly early.
  • Practicing good overall hygiene before and after delivery.

If you have an existing health condition, such as diabetes, you must manage it appropriately to reduce the risk of infections and fever. Studies have shown that maintaining appropriate blood sugar levels may lower the risk of surgical site infections and further complications (2). Certain medications, such as the antibiotic azithromycin, may help prevent postpartum infections and fever. You may speak to your doctor to check if you need it (13).

When To See A Doctor For Postpartum Fever?

A woman’s postpartum health status should be frequently monitored to prevent adverse events and severe medical conditions. You must see a doctor soon if you experience the following conditions (14).

  • Fever higher than 38°C (100.4°F) for more than two days
  • Trouble breathing
  • Chest pain
  • Heavy bleeding (postpartum hemorrhage)
  • Chills or sensitivity to cold
  • Pain, swelling, or discharge at the site of incision
  • Abdominal pain, or burning sensation while urinating
  • Extreme pain in the lower abdominal region
  • Painful breasts and lumps in breast or nipple area
  • Foul-smelling vaginal discharge

A woman’s body undergoes major changes after childbirth, usually causing mild discomforts and fever in weeks postpartum. However, in some cases, a postpartum fever might indicate serious health conditions or complications. Therefore, any signs of infection or abnormal fever post-delivery should not be neglected. The timely diagnosis and treatment of the underlying cause can ensure you stay healthy to take care of your little one and enjoy motherhood.

Key Pointers

  • Women who have a C-section may get the postpartum fever.
  • Endometritis and mastitis are a few conditions that could result in postpartum fever.
  • Treatment, depending on the cause and severity, can include administering antibiotics and other medications.
  • Symptoms such as persistent high fever and acute pain in the breasts or abdomen may indicate an underlying health issue.

References:

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  1. G.Hamadeh, et al., (1995); Postpartum fever.
    https://pubmed.ncbi.nlm.nih.gov/7625327/
  2. Marina Boushra, et al.,Postpartum Infection.
    https://www.ncbi.nlm.nih.gov/books/NBK560804/
  3. Risks-Caesarean section.
    https://www.nhs.uk/conditions/caesarean-section/risks/
  4. Tetsuya Kawakita, et al., (2017); Surgical site infections after cesarean delivery: epidemiology, prevention and treatment
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497372/
  5. E. Dalton, et al.,(2014); Post partum infections: A review for the non-OBGYN.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934978/
  6. Mastitis While Breastfeeding.
    https://www.uofmhealth.org/health-library /hw98039
  7. Tina Djernis Gundersen, et al., (2018); Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857667/pdf/bmjopen-2017-018479.pdf
  8. M.A. Schwartz, et al.,(1999); Risk factors for urinary tract infection in the postpartum period.
    https://pubmed.ncbi.nlm.nih.gov/10486462/
  9. Yannick Lechedem Nguny, et al., (2020); Determinants and aetiologies of postpartum pyrexia; a retrospective analysis in a tertiary health facility in the Littoral Region of Cameroon.
    https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-020-02867-2.pdf.
  10. Bacterial Sepsis following Pregnancy.
    https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf
  11. WHO recommendations for prevention and treatment of maternal peripartum infections.
    https://apps.who.int/iris/bitstream/handle/10665/186171/9789241549363_eng.pdf;jsessionid=4FCFBD6849E3AF708A55D39145E7D07C?sequence=1 et al.
  12. Puerperal sepsis.
    https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/puerperal-sepsis
  13. Mauricio La Rosa, et al., (2019); Incidence and Risk Factors for Hospital Readmission or Unexpected Visits in Women Undergoing Unscheduled Cesarean Delivery.
    https://pubmed.ncbi.nlm.nih.gov/30877684/
  14. Warning Signs Of Health Problems After Birth.
    https://www.marchofdimes.org/pregnancy/warning-signs-of-health-problems-after-birth.aspx
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Dr. Karla S. Sanchez-Banos

(MD)
Dr. Karla S. Sanchez-Banos is a board-licensed Ob/Gyn in Mexico, specializing in Adolescent Gynecology. She is also trained in Gynecological Endocrinology, granted by AMEGIN (Gynecological Endocrinology Mexican Association). Her decade-old experience includes scientific research in teen pregnancy and the use of long-acting reversible contraceptive methods in the adolescent age group.  Dr. Karla currently works in two private medical centers in... more

Vidya Tadapatri

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over four years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology. Vidya writes health-based articles... more