Obstetrics and Gynecology · MU Sofia

34. The pathologic puerperium, puerperal infections. Mastitis

Covers complications of the six weeks after birth, with puerperal infection as the central focus. Sets out the definition of puerperal fever and its common sources, then a table of infection types with their features and treatment, including the sepsis bundle. Goes on to risk factors, then mastitis: its cause, presentation, antibiotic choice and breast abscess. Closes with brief notes on thromboembolism, secondary haemorrhage, mood disorders and urinary or anal incontinence.

Inside: 4 sections · 1 table · 16 flashcards · 2 min

Topic 34 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 235 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Puerperal infection
  3. Mastitis
  4. Other complications

Introduction

The pathological puerperium covers complications in the 6 weeks after birth: infection, haemorrhage, thromboembolism and mental illness. Sepsis and thromboembolism are among the leading direct causes of maternal death.

Puerperal infection

Puerperal fever: temperature ≥ 38 °C on any two of the first 10 days after birth (excluding the first 24 hours), or any fever with signs of sepsis. Common sources: the uterus, the urinary tract, the breasts, wounds, the lungs and legs (thrombosis).

Risk factors: caesarean section, prolonged rupture of membranes, many vaginal examinations, retained products, manual removal of the placenta, anaemia, diabetes, obesity. Prophylactic antibiotics are given at every caesarean section.

Mastitis

  • Usually Staphylococcus aureus entering through cracked nipples, 2–3 weeks after birth; milk stasis is the starting point.
  • Painful red wedge-shaped area, fever, flu-like symptoms.
  • Treatment: continue breastfeeding or expressing (milk is safe for the baby), analgesia, cold packs; flucloxacillin (or cephalexin, clindamycin if allergic) if not better within 12–24 hours.
  • Breast abscess: fluctuant tender mass; ultrasound-guided aspiration or incision and drainage plus antibiotics.

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