Postpregnancy Genital Tract and Wound Infections

Nell Tharpe, CNM, CRNFA, MS


J Midwifery Womens Health. 2008;53(3):236-246. 

In This Article

Abstract and Introduction

Despite the widespread application of standard aseptic techniques during vaginal birth, cesarean birth, and/or termination of pregnancy, postpregnancy infections remain a significant source of maternal morbidity and mortality. Obstetric infection accounts for more than 12% of maternal deaths. Infection occurs most frequently in women who have cesarean births, and following spontaneous or elective termination of pregnancy. Infection is estimated to be the second highest cause of under-reported maternal death in the United States. This article identifies measures to aid in primary prevention and recognition of obstetric infections in order to facilitate early diagnosis and treatment.

Historically, puerperal fever secondary to genital tract infection has been a leading cause of maternal mortality following childbirth and/or abortion.[1] With the advent of improved hygienic practices and the introduction of antibiotics, morbidity and mortality from puerperal infection has decreased significantly and infection is no longer the leading cause of maternal mortality. However, infection remains a significant contributor to postpartum morbidity and is still the leading cause of abortion-related deaths.[2,3,4]

In addition, obstetric infections result in increased health care costs related to prolonged hospital stays, readmission, and the use of oral and parenteral antibiotics.[3,5]

Research has shown that a significant percentage of maternal morbidity may be reduced through changes in patient, practitioner, and system factors.[6] Through an expansion of patient education efforts and the development of collaborative practice models that utilize clear parameters for evaluating and treating women who present with signs of infection after childbirth or abortion, midwives and other primary care providers can reduce unnecessary delay in diagnosis and facilitate prompt consultation or referral when indicated for treatment. This article reviews parameters for screening, evaluation, and treatment of women with pregnancy-related infections following vaginal birth, cesarean birth, or abortion.