Puerperal fever

Puerperal fever is a septic condition arising from endometritis (purulent or putrefactive) following childbirth or abortion - endometritis post partum, abortum.

Causative agents
The most common causative agent is β-hemolytic streptococcus, staphylococci or anaerobes (Clostridium welchii, C. tetani).

Infection entry pathway
The most common route of infection is via the cervix, most often during unprofessional childbirths or criminal abortions.

Pathogenesis
After birth of the placenta, the inner surface of the uterine cavity appears as a large open wound covered with clots – bacteria easily attach and multiply creating a purulent infection (macroscopically the uterus is enlarged, the mucosa is hemorrhagic, pus-covered, with necroses, during putrid endometritis it is covered with smelly gray-green masses and during infections with gaseous anaerobes(Clostridium perfringens seu welchii)the gas accumulates in the uterine cavity- so-called physometra).

Inflammation can spread further:
 * To the muscle of the uterus – myometritis (phlegmona of the smooth muscle, sometimes creating abscesses), then to the parametrium and perimetrium – blood and lymphatic vessels are affected in all layers, leading to peripheral pyemia.
 * Into the uterine tube – purulent salpingitis – from here it spreads into the peritoneal cavity (milder pelveoperitonitis, or severe diffusedperitonitis).

Complications

 * 1) Resorption of toxins and putrefactive products.
 * 2) Generalization of infection (septicopyemia to sepsis).
 * 3) Peritonitis.

Related articles

 * Pregnancy
 * Childbirth
 * Abortion