Postpartum Fever

Michael Moore, MSIV


July 29, 2013

Fever in the postpartum period is a relatively common occurrence, with a frequency of approximately 5-7% of births and the majority of the occurrences happening more than two days after birth.[1] Frequently, these are managed by a patient's attending woman's health specialist, but a brief review is helpful for the emergency medicine physician as they may present in the emergency department for care. Postpartum fever is defined as a temperature of 38.7 degrees C (101.6 degrees F) or greater for the first 24 hours or greater than 38.0 degrees C (100.4 degrees F) on any two of the first 10 days postpartum.[2]

Fever occurring over such a wide range of time during the postpartum course can obviously have a variety of causes. However, the most common cause of postpartum fever is endometritis, which is inflammation in the lining of the uterus, in this case from infection.[3] Given that the source of the infections is both from the genitourinary tract as well as from the skin flora, the infection is usually polymicrobial,[4] requiring the administration of antibiotics with specific activity against anaerobes. This infection usually appears two to three days after delivery, so it is the one most often encountered in the postpartum period accounting for over half of postpartum infections found after discharge post-delivery.[2]

Other significant causes of postpartum fever (in order of temporal occurrence after delivery) include atelectasis, urinary tract infection/pyelonephritis, surgical wound infection (the case of surgical delivery), septic thrombophlebitis and mastitis.[5] Finally, unusual causes of acute abdominal pain should be considered if clinically appropriate, especially appendicitis and diverticulitis, which can be difficult to distinguish in the setting of normal postpartum or postoperative pain.

Diagnostic evaluation by laboratory studies customary in the evaluation of infection by source outlined above, along with appropriate diagnostic studies should be performed, and obstetric consultation should be obtained.[6] Specifically in the treatment of endometritis, especially after surgical delivery, parental clindamycin and gentamycin are recommended along with appropriate fluid resuscitation and supportive care.[7]