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1. Shard Calculation

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Response:

Calculated Shard: 152 (from laksa189)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa152.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Postpartum_infections\')), getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Postpartum_infections\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections","crawl_time":1774023796,"first_indexed_time":1466606603,"http_code":200,"src_unparsed":"org,wikipedia!en,\/wiki\/Postpartum_infections s443","src_root_hash":"17790707453426894952","history_drop_reason":null,"meta_title":"Postpartum infections - Wikipedia","meta_descriptions":[],"attrs_boilerpipe_text":"Postpartum infections\nOther names\nPuerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections\nStreptococcus pyogenes\n(red-stained spheres) is responsible for many cases of severe puerperal fever.\nSpecialty\nObstetrics\nSymptoms\nFever, lower abdominal pain, bad-smelling vaginal discharge\n[\n1\n]\nCauses\nTypically multiple types of bacteria\n[\n1\n]\nRisk factors\nCaesarean section\n,\npremature rupture of membranes\n,\nprolonged labour\n,\nmalnutrition\n,\ndiabetes\n[\n1\n]\n[\n2\n]\nTreatment\nAntibiotics\n[\n1\n]\nFrequency\n11.8 million\n[\n3\n]\nDeaths\n17,900\n[\n4\n]\nPostpartum infections\n, also known as\nchildbed fever\nand\npuerperal fever\n, are any bacterial\ninfections\nof the\nfemale reproductive tract\nfollowing\nchildbirth\nor\nmiscarriage\n.\n[\n1\n]\nSigns and symptoms usually include a\nfever\ngreater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous\nvaginal discharge\n.\n[\n1\n]\nIt usually occurs after the first 24 hours and within the first ten days following delivery.\n[\n5\n]\nThe most common infection is that of the\nuterus\nand surrounding tissues known as\npuerperal sepsis\n,\npostpartum metritis\n, or\npostpartum endometritis\n.\n[\n1\n]\n[\n6\n]\nRisk factors include\ncaesarean section\n(C-section), the presence of certain bacteria such as\ngroup B streptococcus\nin the vagina,\npremature rupture of membranes\n, multiple\nvaginal exams\n, manual removal of the\nplacenta\n, and\nprolonged labour\namong others.\n[\n1\n]\n[\n2\n]\nMost infections involve a number of types of bacteria.\n[\n1\n]\nDiagnosis is rarely helped by\nculturing\nof the vagina or blood.\n[\n1\n]\nIn those who do not improve,\nmedical imaging\nmay be required.\n[\n1\n]\nOther causes of fever following delivery include\nbreast engorgement\n,\nurinary tract infections\n, infections of an abdominal incision or an\nepisiotomy\n, and\natelectasis\n.\n[\n1\n]\n[\n2\n]\nDue to the risks following caesarean section, it is recommended that all women receive a preventive dose of\nantibiotics\nsuch as\nampicillin\naround the time of surgery.\n[\n1\n]\nTreatment of established infections is with antibiotics, with most people improving in two to three days.\n[\n1\n]\nIn those with mild disease, oral antibiotics may be used; otherwise,\nintravenous\nantibiotics are recommended.\n[\n1\n]\nCommon antibiotics include a combination of ampicillin and\ngentamicin\nfollowing vaginal delivery or\nclindamycin\nand gentamicin in those who have had a C-section.\n[\n1\n]\nIn those who are not improving with appropriate treatment, other complications such as an\nabscess\nshould be considered.\n[\n1\n]\nIn 2015, about 11.8 million maternal infections occurred.\n[\n3\n]\nIn the developed world about 1% to 2% develop uterine infections following\nvaginal delivery\n.\n[\n1\n]\nThis increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.\n[\n1\n]\nIn 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.\n[\n4\n]\n[\n7\n]\nThey are the cause of about 10% of deaths around the time of pregnancy.\n[\n2\n]\nThe first known descriptions of the condition date back to at least the 5th century BCE in the writings of\nHippocrates\n.\n[\n8\n]\nThese infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.\n[\n9\n]\nIn 1847, Hungarian physician\nIgnaz Semmelweiss\ndecreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of\nhandwashing\nwith\ncalcium hypochlorite\n.\n[\n10\n]\n[\n11\n]\nSigns and symptoms usually include a\nfever\ngreater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.\n[\n1\n]\nIt usually occurs after the first 24 hours and within the first ten days following delivery.\n[\n5\n]\nAfter childbirth, the\nfemale genital tract\nhas a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the\nuterus\n, or it may spread beyond to cause\nsepsis\nor other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the\nplacenta\n(afterbirth), but\npathogenic\norganisms may also affect\nlacerations\nof any part of the genital tract. By whatever portal, they can invade the\nbloodstream\nand\nlymph system\nto cause\nsepsis\n,\ncellulitis\n(inflammation of connective tissue), and pelvic or generalized\nperitonitis\n(inflammation of the abdominal lining). The severity of the illness depends on the\nvirulence\nof the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are\nStreptococcus pyogenes\n;\nstaphylococci\n(inhabitants of the skin and of\npimples\n,\ncarbuncles\n, and many other\npustular\neruptions); the\nanaerobic streptococci\n, which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery;\nEscherichia coli\n[\n12\n]\nand\nClostridium perfringens\n(inhabitants of the lower bowel); and\nClostridium tetani\n.\n[\n13\n]\nCauses (listed in order of decreasing frequency) include:\nendometritis\n,\nurinary tract infection\n,\npneumonia\n\/\natelectasis\n,\nwound infection\n, and\nseptic pelvic thrombophlebitis\n. Sepsis risk factors for each condition are listed in order of the\npostpartum\nday (PPD) on which the condition generally occurs.\n[\ncitation needed\n]\nPPD 0:\natelectasis\nrisk factors include\ngeneral anesthesia\n,\ncigarette smoking\n, and\nobstructive lung disease\n.\nPPD 1–2: urinary tract infection risk factors include multiple\ncatheterization\nduring labor, multiple\nvaginal examinations\nduring labor, and untreated\nbacteriuria\n.\nPPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.\nPPD 4–5: wound infection risk factors include emergency\ncesarean section\n, prolonged\nmembrane rupture\n, prolonged labor, and multiple vaginal examinations during labor.\nPPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth.\nPPD 7–21:\nmastitis\nrisk factors include nipple trauma from\nbreastfeeding\n.\nPuerperal fever is diagnosed with:\nA temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10)\nOral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)\n[\n14\n]\nPuerperal fever  (from the Latin\npuer\n,\nmale child (boy)\n), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:\n[\n15\n]\nthe specific target of infection:\nendometritis\n(inflammation of the inner lining of the uterus),\nmetrophlebitis\n(inflammation of the veins of the uterus), and\nperitonitis\n(inflammation of the membrane lining of the abdomen).\nthe severity of the infection: less serious\ninfection\n(contained multiplication of microbes) or possibly life-threatening\nsepsis\n(uncontrolled and uncontained multiplication of microbes throughout the bloodstream).\nEndometritis\nis a polymicrobial infection.  It frequently includes organisms such as\nUreaplasma\n,\nStreptococcus\n,\nMycoplasma\n, and\nBacteroides\n, and may also include organisms such as\nGardnerella\n,\nChlamydia\n,\nLactobacillus\n,\nEscherichia\n, and\nStaphylococcus\n.\n[\n16\n]\nDifferential diagnosis\n[\nedit\n]\nSeveral other conditions can cause fevers following delivery, including:\nurinary tract infections\n,\nbreast engorgement\n,\natelectasis\n, and surgical incisions, among others.\n[\n1\n]\nAntibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health.\n[\n2\n]\nIt is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.\n[\n2\n]\nAtelectasis\n: mild to moderate fever, no changes or mild rales on chest\nauscultation\n.\n[\n17\n]\nManagement: pulmonary exercises, ambulation (deep breathing and walking).\nUrinary tract infection\n: high fever, malaise,\ncostovertebral\ntenderness, positive urine culture.\n[\n18\n]\nManagement: antibiotics as per culture sensitivity (cephalosporin).\nEndometritis\n: moderate fever, exquisite uterine tenderness, minimal abdominal findings.\n[\n19\n]\nManagement: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary.\nWound infection\n: persistent spiking fever despite antibiotics, wound\nerythema\nor fluctuance, wound drainage.\n[\n20\n]\nManagement: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure.\nSeptic pelvic thrombophlebitis\n: persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.\n[\n21\n]\nManagement: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values.\nMastitis\n: unilateral, localized erythema,\nedema\n, tenderness.\n[\n22\n]\nManagement: antibiotics for cellulitis, open and drain the abscess if present.\nThe number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.\n[\n14\n]\nGlobally, bacterial infections are the cause of 10% of\nmaternal deaths\n—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.\n[\n2\n]\n[\n23\n]\nIn the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is\ncaesarean section\n.\n[\n24\n]\nThe number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.\n[\n1\n]\nIn the United Kingdom from 1985 to 2005, the number of\ndirect\ndeaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.\n[\n25\n]\nIn 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.\n[\n26\n]\nPuerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to\nchildbirth\n, and was second only to\ntuberculosis\nin killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.\n[\n27\n]\nAlthough it had been recognized from as early as the time of the\nHippocratic corpus\nthat women in childbed were prone to fevers, the distinct name \"puerperal fever\" appears in historical records only from the early 18th century.\n[\n28\n]\nThe death rate for women giving birth decreased in the 20th century in\ndeveloped countries\n. The decline may be partly attributed to improved environmental conditions, better\nobstetrical\ncare, and the use of\nantibiotics\n. Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of\nscarlet fever\n, which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.\n[\n29\n]\n\"The Doctor's Plague\"\n[\nedit\n]\nIn his 1861 book,\nIgnaz Semmelweis\npresented evidence to demonstrate that the advent of\npathological anatomy\nin Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of\nchlorine\nhandwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison (\nview rates\n). His efforts were futile, however.\nFrom the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of\ngerms\n, doctors did not believe hand washing was needed.\n[\n30\n]\nHospitals for childbirth became common in the 17th century in many European cities. These \"lying-in\" hospitals were established at a time when there was no knowledge of\nantisepsis\nor\nepidemiology\n, and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients.\n[\ncitation needed\n]\nThe first recorded epidemic of puerperal fever occurred at the\nHôtel-Dieu de Paris\nin 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.\n[\n31\n]\nIn the early 19th century,\nIgnaz Semmelweis\nnoticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a\nmaternity ward\n. His investigation discovered that washing hands before a delivery with a\ncalcium hypochlorite\nsolution reduced childbed fever fatalities by 90%.\n[\n32\n]\nHis findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.\n[\n33\n]\nThe scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.\n[\n34\n]\nSemmelweis was not the only doctor ignored after sounding a warning about the problem. In his\nTreatise on the Epidemic of Puerperal Fever\n(1795), ex-naval surgeon and\nAberdonian\nobstetrician\nAlexander Gordon\n(1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors.  Gordon wrote, \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"\n[\n35\n]\n[\n36\n]\nIn 1842,\nThomas Watson\n(1792–1882), a professor of medicine at\nKing's College Hospital\n, London, wrote: \"Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent\nablution\n.\" Watson recommended\nhandwashing\nwith\nchlorine\nsolution and changes of clothing for obstetric attendants \"to prevent the practitioner becoming a vehicle of contagion and death between one patient and another.\"\n[\n37\n]\n[\n38\n]\nIn 1843,\nOliver Wendell Holmes Sr.\npublished\nThe Contagiousness of Puerperal Fever\nand controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.\n[\n39\n]\n[\n40\n]\nHolmes quoted Dr. James Blundell as stating, \"... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease.\"\n[\n41\n]\nHolmes' conclusions were ridiculed by many contemporaries, including\nCharles Delucena Meigs\n, a well-known obstetrician, who stated, \"Doctors are gentlemen, and gentlemen's hands are clean.\"\n[\n42\n]\nRichard Gordon states that Holmes' exhortations \"outraged obstetricians, particularly in Philadelphia\".\n[\n43\n]\nIn those days, \"surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon\", \"pus was as inseparable from surgery as blood\", and \"cleanliness was next to prudishness\". He quotes\nSir Frederick Treves\non that era: \"There was no object in being clean.  Indeed, cleanliness was out of place.  It was considered to be finicking and affected.  An executioner might as well manicure his nails before chopping off a head.\"\n[\n44\n]\n[\n45\n]\nIn 1844,\nIgnaz Semmelweis\nwas appointed assistant lecturer in the First Obstetric Division of the\nVienna General Hospital\n(Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague,\nJakob Kolletschka\n, died of sepsis after a student accidentally cut his hand while performing an autopsy.\n[\ncitation needed\n]\nSemmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.\n[\n46\n]\nWhile his results were extraordinary, he was treated with skepticism and ridicule (see\nResponse to Semmelweis\n).\nHe did the same work in St. Rochus hospital in\nPest, Hungary\n, and published his findings in 1860, but his discovery was again ignored.\n[\n47\n]\nIn 1935,\nLeonard Colebrook\nshowed\nProntosil\nwas effective against\nhaemolytic\nstreptococcus\nand hence a cure for puerperal fever.\n[\n48\n]\n[\n49\n]\nElite status was no protection against postpartum infections, as the deaths of several English queens attest.\nElizabeth of York\n, queen consort of\nHenry VII\n, died of puerperal fever one week after giving birth to a daughter, who also died. Her son\nHenry VIII\nhad two wives who died this way,\nJane Seymour\n[\ncitation needed\n]\nand\nCatherine Parr\n.\n[\n50\n]\nSuzanne Barnard, mother of philosopher\nJean-Jacques Rousseau\n, contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that \"I came into the world with so few signs of life that little hope was entertained of preserving me\". He was nursed back to health by an aunt.\n[\n51\n]\nFrench natural philosopher\nÉmilie du Châtelet\ndied in 1749.\nMary Wollstonecraft\n, author of\nVindication of the Rights of Woman\n, died ten days after giving birth to\nher second daughter\n, who grew up to write\nFrankenstein\n. Other notables include African-American poet\nPhillis Wheatley\n(1784), British housekeeping authority\nIsabella Beeton\n(1865),\n[\n52\n]\n[\n53\n]\nand American author\nJean Webster\nin 1916 died of puerperal fever.\n[\ncitation needed\n]\nIn\nCharles Dickens\n' novel\nA Christmas Carol\n, it is implied that both\nScrooge's\nmother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father\n[\ncitation needed\n]\n.\nPostpartum confinement\n, a traditional practice after childbirth\n^\na\nb\nc\nd\ne\nf\ng\nh\ni\nj\nk\nl\nm\nn\no\np\nq\nr\ns\nt\nu\nv\n\"37\".\nWilliams Obstetrics\n(24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37.\nISBN\n \n978-0-07-179893-8\n.\n^\na\nb\nc\nd\ne\nf\ng\nWHO recommendations for prevention and treatment of maternal peripartum infections\n(PDF)\n. World Health Organization. 2015. p. 1.\nISBN\n \n978-92-4-154936-3\n.\nPMID\n \n26598777\n.\nArchived\n(PDF)\nfrom the original on 2016-02-07.\n^\na\nb\nGBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016).\n\"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015\"\n.\nLancet\n.\n388\n(10053):\n1545–\n1602.\ndoi\n:\n10.1016\/S0140-6736(16)31678-6\n.\nPMC\n \n5055577\n.\nPMID\n \n27733282\n.\n^\na\nb\nGBD 2015 Mortality and Causes of Death Collaborators (8 October 2016).\n\"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015\"\n.\nLancet\n.\n388\n(10053):\n1459–\n1544.\ndoi\n:\n10.1016\/s0140-6736(16)31012-1\n.\nPMC\n \n5388903\n.\nPMID\n \n27733281\n.\n^\na\nb\nHiralal Konar (2014).\nDC Dutta's Textbook of Obstetrics\n. JP Medical Ltd. p. 432.\nISBN\n \n978-93-5152-067-2\n.\nArchived\nfrom the original on 2015-12-08.\n^\n\"Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology\".\nHacker & Moore's essentials of obstetrics and gynecology\n(6 ed.). Elsevier Canada. 2015. pp. \n276–\n290.\nISBN\n \n978-1-4557-7558-3\n.\n^\nGBD 2013 Mortality and Causes of Death Collaborators (17 December 2014).\n\"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013\"\n.\nLancet\n.\n385\n(9963):\n117–\n171.\ndoi\n:\n10.1016\/S0140-6736(14)61682-2\n.\nPMC\n \n4340604\n.\nPMID\n \n25530442\n.\n^\nWalvekar V (2005).\nManual of perinatal infections\n. New Delhi: Jaypee Bros. p. 153.\nISBN\n \n978-81-8061-472-9\n.\nArchived\nfrom the original on 2016-03-04.\n^\nMagner LN (1992).\nA history of medicine\n. New York: Dekker. pp. \n257\n–258.\nISBN\n \n978-0-8247-8673-1\n.\n^\nAnderson BL (April 2014). \"Puerperal group A streptococcal infection: beyond Semmelweis\".\nObstetrics and Gynecology\n.\n123\n(4):\n874–\n882.\ndoi\n:\n10.1097\/aog.0000000000000175\n.\nPMID\n \n24785617\n.\nS2CID\n \n24685091\n.\n^\nAtaman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013).\n\"Medicine in stamps-Ignaz Semmelweis and Puerperal Fever\"\n.\nJournal of the Turkish German Gynecological Association\n.\n14\n(1):\n35–\n9.\ndoi\n:\n10.5152\/jtgga.2013.08\n.\nPMC\n \n3881728\n.\nPMID\n \n24592068\n.\n^\nAndy W Wong (2024-03-27).\n\"Postpartum Infections\"\n.\nMedscape\n. Retrieved\n2025-03-14\n.\n^\nBefekadu Tesfaye Oyato (2024-06-20).\n\"Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia\"\n.\nBMJ Open\n.\n14\n(6) e083230.\ndoi\n:\n10.1136\/bmjopen-2023-083230\n.\nPMC\n \n11328626\n.\nPMID\n \n38908838\n.\n^\na\nb\nThe Global Incidence of Puerperal Sepsis Protocol for a Systematic Review\nArchived\n2008-12-17 at the\nWayback Machine\n^\nCarter (2005):98\n^\nBerenson AB (April 1990).\n\"Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents\"\n.\nObstetrics and Gynecology\n.\n75\n(4):\n627–\n629.\nPMID\n \n2314783\n.\nArchived\nfrom the original on 2013-11-03.\n^\n\"Atelectasis\"\n.\nThe Lecturio Medical Concept Library\n. Retrieved\n7 July\n2021\n.\n^\n\"Urinary Tract Infection\"\n.\nCenters for Disease Control and Prevention\n(CDC)\n. 17 April 2015.\nArchived\nfrom the original on 22 February 2016\n. Retrieved\n7 July\n2021\n.\n^\nCrum CP, Lee KR, Nucci MR (2011).\nDiagnostic Gynecologic and Obstetric Pathology E-Book\n. Elsevier Health Sciences. p. 430.\nISBN\n \n978-1-4557-0895-6\n.\n^\nDefinition of \"infection\" from several medical dictionaries\n– Retrieved on 2021-07-07\n^\nCallaghan T.\nBlueprint Obstetrics and Gynecology\n.\n^\nBerens PD (December 2015).\n\"Breast Pain: Engorgement, Nipple Pain, and Mastitis\"\n.\nClinical Obstetrics and Gynecology\n.\n58\n(4):\n902–\n14.\ndoi\n:\n10.1097\/GRF.0000000000000153\n.\nPMID\n \n26512442\n.\nS2CID\n \n13006527\n.\n^\n\"WHO recommendations for prevention and treatment of maternal peripartum infections\"\n(PDF)\n.\nArchived\n(PDF)\nfrom the original on 2016-03-06.\n^\nCarter KC, Carter BR (2005).\nChildbed fever. A scientific biography of Ignaz Semmelweis\n. Transaction Publishers. p. 100.\nISBN\n \n978-1-4128-0467-7\n.\n^\nLewis G\n, ed. (2007).\nSaving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom\n. CEMACH. p. 97.\nISBN\n \n978-0-9533536-8-2\n.\n[\npermanent dead link\n]\n^\nCEMACH: Saving Mothers' Lives 2003–2005\nArchived\n2008-05-21 at the\nWayback Machine\n^\nLoudon I\n(9 March 2000).\nThe Tragedy of Childbed Fever\n(PDF)\n. Oxford University Press, USA. p. 6.\nISBN\n \n978-0-19-820499-2\n. Archived from\nthe original\n(PDF)\non 11 February 2012.\n^\nThe debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8.\n^\nBasetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11).\n\"Scarlet fever: a guide for general practitioners\"\n.\nLondon Journal of Primary Care\n.\n9\n(5):\n77–\n79.\ndoi\n:\n10.1080\/17571472.2017.1365677\n.\nISSN\n \n1757-1472\n.\nPMC\n \n5649319\n.\nPMID\n \n29081840\n.\n^\nRebecca Davis (2015-01-12).\n\"The doctor who championed hand-washing and saved women's lives\"\n.\nNational Public Radio\n. Retrieved\n2025-03-14\n.\n^\nLoudon I. \"Deaths in childbed from the eighteenth century to 1935\".\nMed History\n1986; 30: 1–41\n^\nCaplan CE (1995).\n\"The Childbed Fever Mystery and the Meaning of Medical Journalism\"\n.\nMcGill Journal of Medicine\n.\n1\n(1). Archived from\nthe original\non 2012-07-07.\n^\nWyklicky H, Skopec M (1983). \"Ignaz Philipp Semmelweis, the prophet of bacteriology\".\nInfect Control\n.\n4\n(5):\n367–\n370.\ndoi\n:\n10.1017\/S0195941700059762\n.\nPMID\n \n6354955\n.\nS2CID\n \n25830725\n.\n^\nDe Costa CM (Nov 2002).\n\"\n\"The contagiousness of childbed fever\": a short history of puerperal sepsis and its treatment\"\n.\nThe Medical Journal of Australia\n.\n177\n(\n11–\n12):\n668–\n671.\ndoi\n:\n10.5694\/j.1326-5377.2002.tb05004.x\n.\nPMID\n \n12463995\n.\nS2CID\n \n12164328\n.\nArchived\nfrom the original on 2006-12-03.\n^\nGordon A (1795).\nA Treatise on the Epidemic Puerperal Fever of Aberdeen\n. London, England: G.G. and J. Robinson. pp. \n63\n–64.\nOn  p. 63, Gordon recognized that puerperal fever was infectious: \"But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted.\"  From p. 64:  \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"\n^\n\"Treatise on the Epidemic of Puerperal Fever\"\n. www.general-anaesthesia.com. Archived from\nthe original\non July 20, 2008\n. Retrieved\nSeptember 15,\n2011\n.\n^\nWatson (February 18, 1842).\n\"Lectures on the principles and practice of physic: Diseases of the abdomen\"\n.\nThe London Medical Gazette\n.\n29\n:\n801–\n808.\nFrom p. 806\n: \"Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another.\"\n^\nThe Medical Journal of Australia.\n\"The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment\"\nArchived\n2006-12-03 at the\nWayback Machine\n^\nHolmes OW (1842–1843).\n\"On the contagiousness of puerperal fever\"\n.\nThe New England Quarterly Journal of Medicine\n.\n1\n:\n503–\n530.\n^\nOliver Wendell Holmes:\nThe Contagiousness of Puerperal Fever\nArchived\n2007-02-03 at the\nWayback Machine\n^\n(Holmes, 1842–1843),\np. 510.\n^\nMeigs CD (1854).\nOn the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class\n. Philadelphia, Pennsylvania: Blanchard and Lea. p. \n104\n.\nFrom p. 104:  Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: \"He is a gentlemen who is scrupulously careful of his personal appearance, …  But a gentleman's hands are clean.\"\n^\nGordon R\n(1983). \"Disastrous Motherhood: Tales from the Vienna Wards\".\nGreat Medical Disasters\n. London: Hutchinson & Co. pp. 43–46 [43].\n^\nTreves F (1923). \"Ch. 2: The Old Receiving Room\".\nThe Elephant Man and Other Reminiscences\n. London, England: Cassell and Company, Ltd. pp. \n56\n–57.\n^\nGordon, Richard (1983) p. 44\n^\nRaju TN (1999). \"Ignác Semmelweis and the etiology of fetal and neonatal sepsis\".\nJournal of Perinatology\n.\n19\n(4):\n307–\n310.\ndoi\n:\n10.1038\/sj.jp.7200155\n.\nPMID\n \n10685244\n.\nS2CID\n \n29047987\n.\n^\nChrista Colyer.\n\"Childbed fever: a nineteenth-century mystery,\"\nArchived\n2009-04-16 at the\nWayback Machine\nNational Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003).\n^\nColebrook, L; Kenny, M (June 6, 1936). \"Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil\".\nLancet\n227\n(1): 1279–1286.\n^\nSue Bale, Vanessa Jones (2006).\nWound care nursing\n. Elsevier Health Sciences. p. 54.\nISBN\n \n978-0-7234-3344-6\n. Retrieved\n2009-08-05\n.\n^\nSophie Campbell (2012-08-14).\n\"Sudeley Castle: the curious life and death of Katherine Parr\"\n.\nThe Telegraph\n. Retrieved\n2025-03-14\n.\n^\nQuoted from\nWill Durant\n's \"The Age of Rousseau\".\n[\nfull citation needed\n]\n^\nBeetham M (2004).\n\"Beeton, Samuel Orchart (1831–1877)\"\n.\nOxford Dictionary of National Biography\n(online ed.). Oxford University Press.\ndoi\n:\n10.1093\/ref:odnb\/45481\n. Retrieved\n23 November\n2015\n.\n{{\ncite encyclopedia\n}}\n:  CS1 maint: ref duplicates default (\nlink\n)\n(Subscription,\nWikipedia Library\naccess or\nUK public library membership\nrequired.)\n^\nHughes K\n(2006).\nThe Short Life and Long Times of Mrs Beeton\n. London: HarperCollins Publishers.\nISBN\n \n978-0-7524-6122-9\n.\nChaim W, Burstein E (August 2003). \"Postpartum infection treatments: a review\".\nExpert Opinion on Pharmacotherapy\n(review).\n4\n(8):\n1297–\n313.\ndoi\n:\n10.1517\/14656566.4.8.1297\n.\nPMID\n \n12877638\n.\nS2CID\n \n26781321\n.\nFrench L (August 2003). \"Prevention and treatment of postpartum endometritis\".\nCurrent Women's Health Reports\n(review).\n3\n(4):\n274–\n9.\nPMID\n \n12844449\n.\nCalhoun BC, Brost B (June 1995). \"Emergency management of sudden puerperal fever\".\nObstetrics and Gynecology Clinics of North America\n(review).\n22\n(2):\n357–\n67.\ndoi\n:\n10.1016\/S0889-8545(21)00185-6\n.\nPMID\n \n7651676\n.","attrs_markdown":"[Jump to content](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#bodyContent)\n\nMain menu\n\nMain menu\n\nmove to sidebar\n\nhide\n\nNavigation\n\n- [Main page](https:\/\/en.wikipedia.org\/wiki\/Main_Page \"Visit the main page [z]\")\n- [Contents](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents \"Guides to browsing Wikipedia\")\n- [Current events](https:\/\/en.wikipedia.org\/wiki\/Portal:Current_events \"Articles related to current events\")\n- [Random article](https:\/\/en.wikipedia.org\/wiki\/Special:Random \"Visit a randomly selected article [x]\")\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About \"Learn about Wikipedia and how it works\")\n- [Contact us](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us \"How to contact Wikipedia\")\n\nContribute\n\n- [Help](https:\/\/en.wikipedia.org\/wiki\/Help:Contents \"Guidance on how to use and edit Wikipedia\")\n- [Learn to edit](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction \"Learn how to edit Wikipedia\")\n- [Community portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Community_portal \"The hub for editors\")\n- [Recent changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChanges \"A list of recent changes to Wikipedia [r]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_upload_wizard \"Add images or other media for use on Wikipedia\")\n- [Special pages](https:\/\/en.wikipedia.org\/wiki\/Special:SpecialPages \"A list of all special pages [q]\")\n\n[![](https:\/\/en.wikipedia.org\/static\/images\/icons\/enwiki-25.svg) ![Wikipedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-tagline-en-25.svg)](https:\/\/en.wikipedia.org\/wiki\/Main_Page)\n\n[Search](https:\/\/en.wikipedia.org\/wiki\/Special:Search \"Search Wikipedia [f]\")\n\nAppearance\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Postpartum+infections \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Postpartum+infections \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\nPersonal tools\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Postpartum+infections \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Postpartum+infections \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\n## Contents\nmove to sidebar\n\nhide\n\n- [(Top)](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections)\n- [1 Signs and symptoms](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Signs_and_symptoms)\n- [2 Causes](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Causes)\n  Toggle Causes subsection\n  - [2\\.1 Risk factors](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Risk_factors)\n- [3 Diagnosis](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Diagnosis)\n  Toggle Diagnosis subsection\n  - [3\\.1 Differential diagnosis](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Differential_diagnosis)\n- [4 Management](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Management)\n- [5 Epidemiology](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Epidemiology)\n- [6 History](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#History)\n  Toggle History subsection\n  - [6\\.1 \"The Doctor's Plague\"](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#\"The_Doctor's_Plague\")\n  - [6\\.2 Hygienic measures](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Hygienic_measures)\n  - [6\\.3 Notable cases](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Notable_cases)\n- [7 See also](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#See_also)\n- [8 References](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#References)\n- [9 Further reading](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#Further_reading)\n- [10 External links](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#External_links)\n\nToggle the table of contents\n\n# Postpartum infections\n52 languages\n\n- [العربية](https:\/\/ar.wikipedia.org\/wiki\/%D8%AD%D9%85%D9%89_%D8%A7%D9%84%D9%86%D9%81%D8%A7%D8%B3 \"حمى النفاس – Arabic\")\n- [Azərbaycanca](https:\/\/az.wikipedia.org\/wiki\/Do%C4%9Fu%C5%9F_zaman%C4%B1_temperatur \"Doğuş zamanı temperatur – Azerbaijani\")\n- [বাংলা](https:\/\/bn.wikipedia.org\/wiki\/%E0%A6%AA%E0%A7%8D%E0%A6%B0%E0%A6%B8%E0%A7%8B%E0%A6%AC%E0%A6%A4%E0%A7%8D%E0%A6%A4%E0%A6%B0_%E0%A6%B8%E0%A6%82%E0%A6%95%E0%A7%8D%E0%A6%B0%E0%A6%AE%E0%A6%A3 \"প্রসোবত্তর সংক্রমণ – Bangla\")\n- [Català](https:\/\/ca.wikipedia.org\/wiki\/Infecci%C3%B3_puerperal \"Infecció puerperal – Catalan\")\n- [Čeština](https:\/\/cs.wikipedia.org\/wiki\/Hore%C4%8Dka_omladnic \"Horečka omladnic – Czech\")\n- [Deutsch](https:\/\/de.wikipedia.org\/wiki\/Kindbettfieber \"Kindbettfieber – German\")\n- [Español](https:\/\/es.wikipedia.org\/wiki\/Infecci%C3%B3n_puerperal \"Infección puerperal – Spanish\")\n- [Euskara](https:\/\/eu.wikipedia.org\/wiki\/Infekzio_puerperal \"Infekzio puerperal – Basque\")\n- [فارسی](https:\/\/fa.wikipedia.org\/wiki\/%D8%AA%D8%A8_%D8%B2%D8%A7%DB%8C%D9%85%D8%A7%D9%86 \"تب زایمان – Persian\")\n- [Français](https:\/\/fr.wikipedia.org\/wiki\/Fi%C3%A8vre_puerp%C3%A9rale \"Fièvre puerpérale – French\")\n- [Gaeilge](https:\/\/ga.wikipedia.org\/wiki\/Ionfhabhtuithe_iarthuismidh \"Ionfhabhtuithe iarthuismidh – Irish\")\n- [Avañe'ẽ](https:\/\/gn.wikipedia.org\/wiki\/Membys%E1%BA%BD_rire_p%C3%A1mo \"Membysẽ rire pámo – Guarani\")\n- [ગુજરાતી](https:\/\/gu.wikipedia.org\/wiki\/%E0%AA%AA%E0%AB%8D%E0%AA%B0%E0%AA%B8%E0%AB%82%E0%AA%A4%E0%AA%BF_%E0%AA%9A%E0%AB%87%E0%AA%AA%E0%AB%8B \"પ્રસૂતિ ચેપો – Gujarati\")\n- [עברית](https:\/\/he.wikipedia.org\/wiki\/%D7%96%D7%99%D7%94%D7%95%D7%9D_%D7%9C%D7%99%D7%93%D7%94 \"זיהום לידה – Hebrew\")\n- [हिन्दी](https:\/\/hi.wikipedia.org\/wiki\/%E0%A4%9C%E0%A4%9A%E0%A5%8D%E0%A4%9A%E0%A4%BE_%E0%A4%B8%E0%A4%82%E0%A4%95%E0%A5%8D%E0%A4%B0%E0%A4%AE%E0%A4%A3 \"जच्चा संक्रमण – Hindi\")\n- [Hrvatski](https:\/\/hr.wikipedia.org\/wiki\/Babinja_groznica \"Babinja groznica – Croatian\")\n- [Magyar](https:\/\/hu.wikipedia.org\/wiki\/Gyermek%C3%A1gyi_l%C3%A1z \"Gyermekágyi láz – Hungarian\")\n- [Հայերեն](https:\/\/hy.wikipedia.org\/wiki\/%D5%80%D5%A5%D5%BF%D5%AE%D5%B6%D5%B6%D5%A4%D5%A1%D5%A2%D5%A5%D6%80%D5%A1%D5%AF%D5%A1%D5%B6_%D5%BE%D5%A1%D6%80%D5%A1%D5%AF%D5%B6%D5%A5%D6%80 \"Հետծննդաբերական վարակներ – Armenian\")\n- [Bahasa Indonesia](https:\/\/id.wikipedia.org\/wiki\/Demam_puerperal \"Demam puerperal – Indonesian\")\n- [Igbo](https:\/\/ig.wikipedia.org\/wiki\/%E1%BB%8Cr%E1%BB%8Ba_n%E2%80%99esochi_mgbe_nwaany%E1%BB%8B_m%E1%BB%A5s%E1%BB%8Br%E1%BB%8B_nwa \"Ọrịa n’esochi mgbe nwaanyị mụsịrị nwa – Igbo\")\n- [Italiano](https:\/\/it.wikipedia.org\/wiki\/Febbre_puerperale \"Febbre puerperale – Italian\")\n- [日本語](https:\/\/ja.wikipedia.org\/wiki\/%E7%94%A3%E8%A4%A5%E7%86%B1 \"産褥熱 – Japanese\")\n- [ಕನ್ನಡ](https:\/\/kn.wikipedia.org\/wiki\/%E0%B2%AA%E0%B2%B0%E0%B3%8D%E0%B2%AA%E0%B3%8D%E0%B2%AF%E0%B3%81%E0%B2%B0%E0%B2%BE%E0%B2%A6_%E0%B2%B8%E0%B3%8B%E0%B2%82%E0%B2%95%E0%B3%81%E0%B2%97%E0%B2%B3%E0%B3%81 \"ಪರ್ಪ್ಯುರಾದ ಸೋಂಕುಗಳು – Kannada\")\n- [한국어](https:\/\/ko.wikipedia.org\/wiki\/%EC%82%B0%EC%9A%95%EC%97%B4 \"산욕열 – Korean\")\n- [Lietuvių](https:\/\/lt.wikipedia.org\/wiki\/Postnatalin%C4%97s_infekcin%C4%97s_ligos \"Postnatalinės infekcinės ligos – Lithuanian\")\n- [Madhurâ](https:\/\/mad.wikipedia.org\/wiki\/Demam_puerperal \"Demam puerperal – Madurese\")\n- [മലയാളം](https:\/\/ml.wikipedia.org\/wiki\/%E0%B4%AA%E0%B5%8B%E0%B4%B8%E0%B5%8D%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B5%8D%E2%80%8C%E0%B4%AA%E0%B4%BE%E0%B5%BC%E0%B4%9F%E0%B5%8D%E0%B4%9F%E0%B4%82_%E0%B4%85%E0%B4%A3%E0%B5%81%E0%B4%AC%E0%B4%BE%E0%B4%A7%E0%B4%95%E0%B5%BE \"പോസ്റ്റ്‌പാർട്ടം അണുബാധകൾ – Malayalam\")\n- [मराठी](https:\/\/mr.wikipedia.org\/wiki\/%E0%A4%AA%E0%A5%8D%E0%A4%B0%E0%A4%B8%E0%A4%B5%E0%A5%8B%E0%A4%A4%E0%A5%8D%E0%A4%A4%E0%A4%B0_%E0%A4%9C%E0%A4%82%E0%A4%A4%E0%A5%81%E0%A4%B8%E0%A4%82%E0%A4%B8%E0%A4%B0%E0%A5%8D%E0%A4%97 \"प्रसवोत्तर जंतुसंसर्ग – Marathi\")\n- [Bahasa Melayu](https:\/\/ms.wikipedia.org\/wiki\/Jangkitan_selepas_bersalin \"Jangkitan selepas bersalin – Malay\")\n- [မြန်မာဘာသာ](https:\/\/my.wikipedia.org\/wiki\/%E1%80%99%E1%80%AE%E1%80%B8%E1%80%96%E1%80%BD%E1%80%AC%E1%80%B8%E1%80%95%E1%80%BC%E1%80%AE%E1%80%B8%E1%80%9B%E1%80%B1%E1%80%AC%E1%80%82%E1%80%AB%E1%80%95%E1%80%AD%E1%80%AF%E1%80%B8%E1%80%9D%E1%80%84%E1%80%BA%E1%80%81%E1%80%BC%E1%80%84%E1%80%BA%E1%80%B8 \"မီးဖွားပြီးရောဂါပိုးဝင်ခြင်း – Burmese\")\n- [Nederlands](https:\/\/nl.wikipedia.org\/wiki\/Kraamvrouwenkoorts \"Kraamvrouwenkoorts – Dutch\")\n- [Norsk bokmål](https:\/\/no.wikipedia.org\/wiki\/Barselfeber \"Barselfeber – Norwegian Bokmål\")\n- [Chi-Chewa](https:\/\/ny.wikipedia.org\/wiki\/Matenda_oyamba_chifukwa_cha_uchembere \"Matenda oyamba chifukwa cha uchembere – Nyanja\")\n- [ଓଡ଼ିଆ](https:\/\/or.wikipedia.org\/wiki\/%E0%AC%AA%E0%AD%8D%E0%AC%B0%E0%AC%B8%E0%AC%AC_%E0%AC%B8%E0%AC%82%E0%AC%95%E0%AD%8D%E0%AC%B0%E0%AC%AE%E0%AC%A3 \"ପ୍ରସବ ସଂକ୍ରମଣ – Odia\")\n- [Polski](https:\/\/pl.wikipedia.org\/wiki\/Zaka%C5%BCenie_po%C5%82ogowe \"Zakażenie połogowe – Polish\")\n- [Português](https:\/\/pt.wikipedia.org\/wiki\/Infe%C3%A7%C3%A3o_puerperal \"Infeção puerperal – Portuguese\")\n- [Română](https:\/\/ro.wikipedia.org\/wiki\/Febr%C4%83_puerperal%C4%83 \"Febră puerperală – Romanian\")\n- [Русский](https:\/\/ru.wikipedia.org\/wiki\/%D0%A0%D0%BE%D0%B4%D0%B8%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%B3%D0%BE%D1%80%D1%8F%D1%87%D0%BA%D0%B0 \"Родильная горячка – Russian\")\n- [Srpskohrvatski \/ српскохрватски](https:\/\/sh.wikipedia.org\/wiki\/Porodiljska_groznica \"Porodiljska groznica – Serbo-Croatian\")\n- [Simple English](https:\/\/simple.wikipedia.org\/wiki\/Childbed_fever \"Childbed fever – Simple English\")\n- [ChiShona](https:\/\/sn.wikipedia.org\/wiki\/Utachiona_hwemunzira_inobuda_nemwana \"Utachiona hwemunzira inobuda nemwana – Shona\")\n- [Српски \/ srpski](https:\/\/sr.wikipedia.org\/wiki\/Porodiljska_groznica \"Porodiljska groznica – Serbian\")\n- [Sesotho](https:\/\/st.wikipedia.org\/wiki\/Ditshwaetso_tsa_ka_mora_ho_beleha \"Ditshwaetso tsa ka mora ho 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[Read](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=history \"Past revisions of this page [h]\")\n\nTools\n\nTools\n\nmove to sidebar\n\nhide\n\nActions\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=history)\n\nGeneral\n\n- [What links here](https:\/\/en.wikipedia.org\/wiki\/Special:WhatLinksHere\/Postpartum_infections \"List of all English Wikipedia pages containing links to this page [j]\")\n- [Related changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChangesLinked\/Postpartum_infections \"Recent changes in pages linked from this 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version](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&printable=yes \"Printable version of this page [p]\")\n\nIn other projects\n\n- [Wikimedia Commons](https:\/\/commons.wikimedia.org\/wiki\/Category:Postpartum_infections)\n- [Wikidata item](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q1419347 \"Structured data on this page hosted by Wikidata [g]\")\n\nAppearance\n\nmove to sidebar\n\nhide\n\nFrom Wikipedia, the free encyclopedia\n\nHuman disease\n\nMedical condition\n\n| Postpartum infections |   |\n|---|---|\n| Other names | Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections |\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e4\/Streptococcus_pyogenes.jpg\/250px-Streptococcus_pyogenes.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:Streptococcus_pyogenes.jpg) |   |\n| *[Streptococcus pyogenes](https:\/\/en.wikipedia.org\/wiki\/Streptococcus_pyogenes \"Streptococcus pyogenes\")* (red-stained spheres) is responsible for many cases of severe puerperal fever. |   |\n| [Specialty](https:\/\/en.wikipedia.org\/wiki\/Medical_specialty \"Medical specialty\") | [Obstetrics](https:\/\/en.wikipedia.org\/wiki\/Obstetrics \"Obstetrics\") |\n| [Symptoms](https:\/\/en.wikipedia.org\/wiki\/Signs_and_symptoms \"Signs and symptoms\") | Fever, lower abdominal pain, bad-smelling vaginal discharge[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| [Causes](https:\/\/en.wikipedia.org\/wiki\/Cause_\\(medicine\\) \"Cause (medicine)\") | Typically multiple types of bacteria[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| [Risk factors](https:\/\/en.wikipedia.org\/wiki\/Risk_factor \"Risk factor\") | [Caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\"), [premature rupture of membranes](https:\/\/en.wikipedia.org\/wiki\/Premature_rupture_of_membranes \"Premature rupture of membranes\"), [prolonged labour](https:\/\/en.wikipedia.org\/wiki\/Prolonged_labour \"Prolonged labour\"), [malnutrition](https:\/\/en.wikipedia.org\/wiki\/Malnutrition \"Malnutrition\"), [diabetes](https:\/\/en.wikipedia.org\/wiki\/Diabetes \"Diabetes\")[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) |\n| Treatment | [Antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotics \"Antibiotics\")[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| Frequency | 11\\.8 million[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015Pre-3) |\n| Deaths | 17,900[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015De-4) |\n\n**Postpartum infections**, also known as **childbed fever** and **puerperal fever**, are any bacterial [infections](https:\/\/en.wikipedia.org\/wiki\/Infection \"Infection\") of the [female reproductive tract](https:\/\/en.wikipedia.org\/wiki\/Female_reproductive_tract \"Female reproductive tract\") following [childbirth](https:\/\/en.wikipedia.org\/wiki\/Childbirth \"Childbirth\") or [miscarriage](https:\/\/en.wikipedia.org\/wiki\/Miscarriage \"Miscarriage\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Signs and symptoms usually include a [fever](https:\/\/en.wikipedia.org\/wiki\/Fever \"Fever\") greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous [vaginal discharge](https:\/\/en.wikipedia.org\/wiki\/Vaginal_discharge \"Vaginal discharge\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hir2014-5)\n\nThe most common infection is that of the [uterus](https:\/\/en.wikipedia.org\/wiki\/Uterus \"Uterus\") and surrounding tissues known as **puerperal sepsis**, **postpartum metritis**, or **postpartum endometritis**.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hac2015-6) Risk factors include [caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\") (C-section), the presence of certain bacteria such as [group B streptococcus](https:\/\/en.wikipedia.org\/wiki\/Group_B_streptococcus \"Group B streptococcus\") in the vagina, [premature rupture of membranes](https:\/\/en.wikipedia.org\/wiki\/Premature_rupture_of_membranes \"Premature rupture of membranes\"), multiple [vaginal exams](https:\/\/en.wikipedia.org\/wiki\/Vaginal_exam \"Vaginal exam\"), manual removal of the [placenta](https:\/\/en.wikipedia.org\/wiki\/Placenta \"Placenta\"), and [prolonged labour](https:\/\/en.wikipedia.org\/wiki\/Prolonged_labour \"Prolonged labour\") among others.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) Most infections involve a number of types of bacteria.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Diagnosis is rarely helped by [culturing](https:\/\/en.wikipedia.org\/wiki\/Microbiological_culture \"Microbiological culture\") of the vagina or blood.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those who do not improve, [medical imaging](https:\/\/en.wikipedia.org\/wiki\/Medical_imaging \"Medical imaging\") may be required.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Other causes of fever following delivery include [breast engorgement](https:\/\/en.wikipedia.org\/wiki\/Breast_engorgement \"Breast engorgement\"), [urinary tract infections](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"), infections of an abdominal incision or an [episiotomy](https:\/\/en.wikipedia.org\/wiki\/Episiotomy \"Episiotomy\"), and [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)\n\nDue to the risks following caesarean section, it is recommended that all women receive a preventive dose of [antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotic \"Antibiotic\") such as [ampicillin](https:\/\/en.wikipedia.org\/wiki\/Ampicillin \"Ampicillin\") around the time of surgery.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Treatment of established infections is with antibiotics, with most people improving in two to three days.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those with mild disease, oral antibiotics may be used; otherwise, [intravenous](https:\/\/en.wikipedia.org\/wiki\/Intravenous \"Intravenous\") antibiotics are recommended.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Common antibiotics include a combination of ampicillin and [gentamicin](https:\/\/en.wikipedia.org\/wiki\/Gentamicin \"Gentamicin\") following vaginal delivery or [clindamycin](https:\/\/en.wikipedia.org\/wiki\/Clindamycin \"Clindamycin\") and gentamicin in those who have had a C-section.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those who are not improving with appropriate treatment, other complications such as an [abscess](https:\/\/en.wikipedia.org\/wiki\/Abscess \"Abscess\") should be considered.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\nIn 2015, about 11.8 million maternal infections occurred.[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015Pre-3) In the developed world about 1% to 2% develop uterine infections following [vaginal delivery](https:\/\/en.wikipedia.org\/wiki\/Vaginal_delivery \"Vaginal delivery\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015De-4)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GDB2013-7) They are the cause of about 10% of deaths around the time of pregnancy.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) The first known descriptions of the condition date back to at least the 5th century BCE in the writings of [Hippocrates](https:\/\/en.wikipedia.org\/wiki\/Hippocrates \"Hippocrates\").[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-8) These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-9) In 1847, Hungarian physician [Ignaz Semmelweiss](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweiss \"Ignaz Semmelweiss\") decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of [handwashing](https:\/\/en.wikipedia.org\/wiki\/Handwashing \"Handwashing\") with [calcium hypochlorite](https:\/\/en.wikipedia.org\/wiki\/Calcium_hypochlorite \"Calcium hypochlorite\").[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-10)[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-11)\n\n## Signs and symptoms\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=1 \"Edit section: Signs and symptoms\")\\]\n\nSigns and symptoms usually include a [fever](https:\/\/en.wikipedia.org\/wiki\/Fever \"Fever\") greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hir2014-5)\n\n## Causes\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=2 \"Edit section: Causes\")\\]\n\nAfter childbirth, the [female genital tract](https:\/\/en.wikipedia.org\/wiki\/Female_reproductive_system \"Female reproductive system\") has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the [uterus](https:\/\/en.wikipedia.org\/wiki\/Uterus \"Uterus\"), or it may spread beyond to cause [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\") or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the [placenta](https:\/\/en.wikipedia.org\/wiki\/Placenta \"Placenta\") (afterbirth), but [pathogenic](https:\/\/en.wikipedia.org\/wiki\/Pathogenic \"Pathogenic\") organisms may also affect [lacerations](https:\/\/en.wikipedia.org\/wiki\/Lacerations \"Lacerations\") of any part of the genital tract. By whatever portal, they can invade the [bloodstream](https:\/\/en.wikipedia.org\/wiki\/Bloodstream \"Bloodstream\") and [lymph system](https:\/\/en.wikipedia.org\/wiki\/Lymph_system \"Lymph system\") to cause [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\"), [cellulitis](https:\/\/en.wikipedia.org\/wiki\/Cellulitis \"Cellulitis\") (inflammation of connective tissue), and pelvic or generalized [peritonitis](https:\/\/en.wikipedia.org\/wiki\/Peritonitis \"Peritonitis\") (inflammation of the abdominal lining). The severity of the illness depends on the [virulence](https:\/\/en.wikipedia.org\/wiki\/Virulence \"Virulence\") of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are *[Streptococcus pyogenes](https:\/\/en.wikipedia.org\/wiki\/Streptococcus_pyogenes \"Streptococcus pyogenes\")*; [staphylococci](https:\/\/en.wikipedia.org\/wiki\/Staphylococci \"Staphylococci\") (inhabitants of the skin and of [pimples](https:\/\/en.wikipedia.org\/wiki\/Pimples \"Pimples\"), [carbuncles](https:\/\/en.wikipedia.org\/wiki\/Carbuncles \"Carbuncles\"), and many other [pustular](https:\/\/en.wikipedia.org\/wiki\/Pustular \"Pustular\") eruptions); the [anaerobic streptococci](https:\/\/en.wikipedia.org\/wiki\/Peptostreptococcus \"Peptostreptococcus\"), which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; *[Escherichia coli](https:\/\/en.wikipedia.org\/wiki\/Escherichia_coli \"Escherichia coli\")*[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-12) and *[Clostridium perfringens](https:\/\/en.wikipedia.org\/wiki\/Clostridium_perfringens \"Clostridium perfringens\")* (inhabitants of the lower bowel); and *[Clostridium tetani](https:\/\/en.wikipedia.org\/wiki\/Clostridium_tetani \"Clostridium tetani\")*.[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-13)\n\n### Risk factors\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=3 \"Edit section: Risk factors\")\\]\n\nCauses (listed in order of decreasing frequency) include: [endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\"), [urinary tract infection](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"), [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\")\/[atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"), [wound infection](https:\/\/en.wikipedia.org\/wiki\/Wound_infection \"Wound infection\"), and [septic pelvic thrombophlebitis](https:\/\/en.wikipedia.org\/wiki\/Septic_pelvic_thrombophlebitis \"Septic pelvic thrombophlebitis\"). Sepsis risk factors for each condition are listed in order of the [postpartum](https:\/\/en.wikipedia.org\/wiki\/Postpartum \"Postpartum\") day (PPD) on which the condition generally occurs.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\n- PPD 0: [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\") risk factors include [general anesthesia](https:\/\/en.wikipedia.org\/wiki\/General_anesthesia \"General anesthesia\"), [cigarette smoking](https:\/\/en.wikipedia.org\/wiki\/Cigarette_smoking \"Cigarette smoking\"), and [obstructive lung disease](https:\/\/en.wikipedia.org\/wiki\/Obstructive_lung_disease \"Obstructive lung disease\").\n- PPD 1–2: urinary tract infection risk factors include multiple [catheterization](https:\/\/en.wikipedia.org\/wiki\/Catheterization \"Catheterization\") during labor, multiple [vaginal examinations](https:\/\/en.wikipedia.org\/wiki\/Vaginal_examination \"Vaginal examination\") during labor, and untreated [bacteriuria](https:\/\/en.wikipedia.org\/wiki\/Bacteriuria \"Bacteriuria\").\n- PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.\n- PPD 4–5: wound infection risk factors include emergency [cesarean section](https:\/\/en.wikipedia.org\/wiki\/Cesarean_section \"Cesarean section\"), prolonged [membrane rupture](https:\/\/en.wikipedia.org\/wiki\/Membrane_rupture \"Membrane rupture\"), prolonged labor, and multiple vaginal examinations during labor.\n- PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth.\n- PPD 7–21: [mastitis](https:\/\/en.wikipedia.org\/wiki\/Mastitis \"Mastitis\") risk factors include nipple trauma from [breastfeeding](https:\/\/en.wikipedia.org\/wiki\/Breastfeeding \"Breastfeeding\").\n\n## Diagnosis\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=4 \"Edit section: Diagnosis\")\\]\n\nPuerperal fever is diagnosed with:\n\n- A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10)\n- Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-gfmer.ch-14)\n\nPuerperal fever (from the Latin *puer*, *male child (boy)*), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-15)\n\n1. the specific target of infection: [endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\") (inflammation of the inner lining of the uterus), [metrophlebitis](https:\/\/en.wikipedia.org\/w\/index.php?title=Metrophlebitis&action=edit&redlink=1 \"Metrophlebitis (page does not exist)\") (inflammation of the veins of the uterus), and [peritonitis](https:\/\/en.wikipedia.org\/wiki\/Peritonitis \"Peritonitis\") (inflammation of the membrane lining of the abdomen).\n2. the severity of the infection: less serious [infection](https:\/\/en.wikipedia.org\/wiki\/Infection \"Infection\") (contained multiplication of microbes) or possibly life-threatening [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\") (uncontrolled and uncontained multiplication of microbes throughout the bloodstream).\n\n[Endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\") is a polymicrobial infection. It frequently includes organisms such as *[Ureaplasma](https:\/\/en.wikipedia.org\/wiki\/Ureaplasma \"Ureaplasma\")*, *[Streptococcus](https:\/\/en.wikipedia.org\/wiki\/Streptococcus \"Streptococcus\")*, *[Mycoplasma](https:\/\/en.wikipedia.org\/wiki\/Mycoplasma \"Mycoplasma\")*, and *[Bacteroides](https:\/\/en.wikipedia.org\/wiki\/Bacteroides \"Bacteroides\")*, and may also include organisms such as *[Gardnerella](https:\/\/en.wikipedia.org\/wiki\/Gardnerella \"Gardnerella\")*, *[Chlamydia](https:\/\/en.wikipedia.org\/wiki\/Chlamydia_\\(bacterium\\) \"Chlamydia (bacterium)\")*, *[Lactobacillus](https:\/\/en.wikipedia.org\/wiki\/Lactobacillus \"Lactobacillus\")*, *[Escherichia](https:\/\/en.wikipedia.org\/wiki\/Escherichia \"Escherichia\")*, and *[Staphylococcus](https:\/\/en.wikipedia.org\/wiki\/Staphylococcus \"Staphylococcus\")*.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-16)\n\n### Differential diagnosis\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=5 \"Edit section: Differential diagnosis\")\\]\n\nSeveral other conditions can cause fevers following delivery, including: [urinary tract infections](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infections \"Urinary tract infections\"), [breast engorgement](https:\/\/en.wikipedia.org\/wiki\/Breast_engorgement \"Breast engorgement\"), [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"), and surgical incisions, among others.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\n## Management\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=6 \"Edit section: Management\")\\]\n\nAntibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)\n\n[Atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"): mild to moderate fever, no changes or mild rales on chest [auscultation](https:\/\/en.wikipedia.org\/wiki\/Auscultation \"Auscultation\").[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-17)\n\nManagement: pulmonary exercises, ambulation (deep breathing and walking).\n\n[Urinary tract infection](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"): high fever, malaise, [costovertebral](https:\/\/en.wikipedia.org\/wiki\/Costovertebral_angle_tenderness \"Costovertebral angle tenderness\") tenderness, positive urine culture.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-18)\n\nManagement: antibiotics as per culture sensitivity (cephalosporin).\n\n[Endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\"): moderate fever, exquisite uterine tenderness, minimal abdominal findings.[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-19)\n\nManagement: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary.\n\n[Wound infection](https:\/\/en.wikipedia.org\/wiki\/Wound_infection \"Wound infection\"): persistent spiking fever despite antibiotics, wound [erythema](https:\/\/en.wikipedia.org\/wiki\/Erythema \"Erythema\") or fluctuance, wound drainage.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-20)\n\nManagement: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure.\n\n[Septic pelvic thrombophlebitis](https:\/\/en.wikipedia.org\/wiki\/Septic_pelvic_thrombophlebitis \"Septic pelvic thrombophlebitis\"): persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-21)\n\nManagement: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values.\n\n[Mastitis](https:\/\/en.wikipedia.org\/wiki\/Mastitis \"Mastitis\"): unilateral, localized erythema, [edema](https:\/\/en.wikipedia.org\/wiki\/Edema \"Edema\"), tenderness.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-22)\n\nManagement: antibiotics for cellulitis, open and drain the abscess if present.\n\n## Epidemiology\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=7 \"Edit section: Epidemiology\")\\]\n\nThe number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-gfmer.ch-14) Globally, bacterial infections are the cause of 10% of [maternal deaths](https:\/\/en.wikipedia.org\/wiki\/Maternal_death \"Maternal death\")—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-23)\n\nIn the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is [caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\").[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-24) The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\nIn the United Kingdom from 1985 to 2005, the number of *direct* deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-25) In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-26)\n\nPuerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to [childbirth](https:\/\/en.wikipedia.org\/wiki\/Childbirth \"Childbirth\"), and was second only to [tuberculosis](https:\/\/en.wikipedia.org\/wiki\/Tuberculosis \"Tuberculosis\") in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-27)\n\n## History\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=8 \"Edit section: History\")\\]\n\nAlthough it had been recognized from as early as the time of the [Hippocratic corpus](https:\/\/en.wikipedia.org\/wiki\/Hippocratic_corpus \"Hippocratic corpus\") that women in childbed were prone to fevers, the distinct name \"puerperal fever\" appears in historical records only from the early 18th century.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-28)\n\nThe death rate for women giving birth decreased in the 20th century in [developed countries](https:\/\/en.wikipedia.org\/wiki\/Developed_countries \"Developed countries\"). The decline may be partly attributed to improved environmental conditions, better [obstetrical](https:\/\/en.wikipedia.org\/wiki\/Obstetrical \"Obstetrical\") care, and the use of [antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotics \"Antibiotics\"). Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of [scarlet fever](https:\/\/en.wikipedia.org\/wiki\/Scarlet_fever \"Scarlet fever\"), which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-29)\n\n### \"The Doctor's Plague\"\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=9 \"Edit section: \\\"The Doctor's Plague\\\"\")\\]\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/Yearly_mortality_rates_1784-1849.png\/330px-Yearly_mortality_rates_1784-1849.png)](https:\/\/en.wikipedia.org\/wiki\/File:Yearly_mortality_rates_1784-1849.png)\n\nIn his 1861 book, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") presented evidence to demonstrate that the advent of [pathological anatomy](https:\/\/en.wikipedia.org\/wiki\/Pathological_anatomy \"Pathological anatomy\") in Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of [chlorine](https:\/\/en.wikipedia.org\/wiki\/Chlorine \"Chlorine\") handwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison ([view rates](https:\/\/en.wikipedia.org\/wiki\/Historical_mortality_rates_of_puerperal_fever#Yearly_mortality_rates_for_birth_giving_women_1784-1849 \"Historical mortality rates of puerperal fever\")). His efforts were futile, however.\n\nFrom the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of [germs](https:\/\/en.wikipedia.org\/wiki\/Microorganism \"Microorganism\"), doctors did not believe hand washing was needed.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-30)\n\nHospitals for childbirth became common in the 17th century in many European cities. These \"lying-in\" hospitals were established at a time when there was no knowledge of [antisepsis](https:\/\/en.wikipedia.org\/wiki\/Antisepsis \"Antisepsis\") or [epidemiology](https:\/\/en.wikipedia.org\/wiki\/Epidemiology \"Epidemiology\"), and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nThe first recorded epidemic of puerperal fever occurred at the [Hôtel-Dieu de Paris](https:\/\/en.wikipedia.org\/wiki\/H%C3%B4tel-Dieu_de_Paris \"Hôtel-Dieu de Paris\") in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-31)\n\nIn the early 19th century, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a [maternity ward](https:\/\/en.wikipedia.org\/wiki\/Maternity_ward \"Maternity ward\"). His investigation discovered that washing hands before a delivery with a [calcium hypochlorite](https:\/\/en.wikipedia.org\/wiki\/Calcium_hypochlorite \"Calcium hypochlorite\") solution reduced childbed fever fatalities by 90%.[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-32) His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Ignaz_Semmelweis-33) The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-childbed_fever-34)\n\nSemmelweis was not the only doctor ignored after sounding a warning about the problem. In his *Treatise on the Epidemic of Puerperal Fever* (1795), ex-naval surgeon and [Aberdonian](https:\/\/en.wikipedia.org\/wiki\/Aberdeen \"Aberdeen\") obstetrician [Alexander Gordon](https:\/\/en.wikipedia.org\/wiki\/Alexander_Gordon_\\(physician\\) \"Alexander Gordon (physician)\") (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-35)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Dr_Alexander_Gordon-36)\n\nIn 1842, [Thomas Watson](https:\/\/en.wikipedia.org\/wiki\/Sir_Thomas_Watson,_1st_Baronet \"Sir Thomas Watson, 1st Baronet\") (1792–1882), a professor of medicine at [King's College Hospital](https:\/\/en.wikipedia.org\/wiki\/King%27s_College_Hospital \"King's College Hospital\"), London, wrote: \"Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent [ablution](https:\/\/en.wikipedia.org\/wiki\/Hygiene \"Hygiene\").\" Watson recommended [handwashing](https:\/\/en.wikipedia.org\/wiki\/Handwashing \"Handwashing\") with [chlorine](https:\/\/en.wikipedia.org\/wiki\/Chlorine \"Chlorine\") solution and changes of clothing for obstetric attendants \"to prevent the practitioner becoming a vehicle of contagion and death between one patient and another.\"[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-37)[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-38)\n\n### Hygienic measures\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=10 \"Edit section: Hygienic measures\")\\]\n\nIn 1843, [Oliver Wendell Holmes Sr.](https:\/\/en.wikipedia.org\/wiki\/Oliver_Wendell_Holmes_Sr. \"Oliver Wendell Holmes Sr.\") published *The Contagiousness of Puerperal Fever* and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-39)[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-bartleby.com-40) Holmes quoted Dr. James Blundell as stating, \"... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease.\"[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-41)\n\nHolmes' conclusions were ridiculed by many contemporaries, including [Charles Delucena Meigs](https:\/\/en.wikipedia.org\/wiki\/Charles_Delucena_Meigs \"Charles Delucena Meigs\"), a well-known obstetrician, who stated, \"Doctors are gentlemen, and gentlemen's hands are clean.\"[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-42) Richard Gordon states that Holmes' exhortations \"outraged obstetricians, particularly in Philadelphia\".[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GordononMotherhood-43) In those days, \"surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon\", \"pus was as inseparable from surgery as blood\", and \"cleanliness was next to prudishness\". He quotes [Sir Frederick Treves](https:\/\/en.wikipedia.org\/wiki\/Sir_Frederick_Treves,_1st_Baronet \"Sir Frederick Treves, 1st Baronet\") on that era: \"There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head.\"[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-44)[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GordononMotherhood44-45)\n\nIn 1844, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") was appointed assistant lecturer in the First Obstetric Division of the [Vienna General Hospital](https:\/\/en.wikipedia.org\/wiki\/Vienna_General_Hospital \"Vienna General Hospital\") (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, [Jakob Kolletschka](https:\/\/en.wikipedia.org\/wiki\/Jakob_Kolletschka \"Jakob Kolletschka\"), died of sepsis after a student accidentally cut his hand while performing an autopsy.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nSemmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-raju-46) While his results were extraordinary, he was treated with skepticism and ridicule (see [Response to Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Contemporary_reaction_to_Ignaz_Semmelweis \"Contemporary reaction to Ignaz Semmelweis\")).\n\nHe did the same work in St. Rochus hospital in [Pest, Hungary](https:\/\/en.wikipedia.org\/wiki\/Pest,_Hungary \"Pest, Hungary\"), and published his findings in 1860, but his discovery was again ignored.[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-colyer-47)\n\nIn 1935, [Leonard Colebrook](https:\/\/en.wikipedia.org\/wiki\/Leonard_Colebrook \"Leonard Colebrook\") showed [Prontosil](https:\/\/en.wikipedia.org\/wiki\/Prontosil \"Prontosil\") was effective against [haemolytic](https:\/\/en.wikipedia.org\/wiki\/Haemolysis \"Haemolysis\") [streptococcus](https:\/\/en.wikipedia.org\/wiki\/Streptococcus \"Streptococcus\") and hence a cure for puerperal fever.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-49)\n\n### Notable cases\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=11 \"Edit section: Notable cases\")\\]\n\nSee also: [List of women who died in childbirth](https:\/\/en.wikipedia.org\/wiki\/List_of_women_who_died_in_childbirth \"List of women who died in childbirth\")\n\nElite status was no protection against postpartum infections, as the deaths of several English queens attest. [Elizabeth of York](https:\/\/en.wikipedia.org\/wiki\/Elizabeth_of_York \"Elizabeth of York\"), queen consort of [Henry VII](https:\/\/en.wikipedia.org\/wiki\/Henry_VII_of_England \"Henry VII of England\"), died of puerperal fever one week after giving birth to a daughter, who also died. Her son [Henry VIII](https:\/\/en.wikipedia.org\/wiki\/Henry_VIII \"Henry VIII\") had two wives who died this way, [Jane Seymour](https:\/\/en.wikipedia.org\/wiki\/Jane_Seymour \"Jane Seymour\")\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\] and [Catherine Parr](https:\/\/en.wikipedia.org\/wiki\/Catherine_Parr \"Catherine Parr\").[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-50)\n\nSuzanne Barnard, mother of philosopher [Jean-Jacques Rousseau](https:\/\/en.wikipedia.org\/wiki\/Jean-Jacques_Rousseau \"Jean-Jacques Rousseau\"), contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that \"I came into the world with so few signs of life that little hope was entertained of preserving me\". He was nursed back to health by an aunt.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-51) French natural philosopher [Émilie du Châtelet](https:\/\/en.wikipedia.org\/wiki\/%C3%89milie_du_Ch%C3%A2telet \"Émilie du Châtelet\") died in 1749. [Mary Wollstonecraft](https:\/\/en.wikipedia.org\/wiki\/Mary_Wollstonecraft \"Mary Wollstonecraft\"), author of *[Vindication of the Rights of Woman](https:\/\/en.wikipedia.org\/wiki\/Vindication_of_the_Rights_of_Woman \"Vindication of the Rights of Woman\")*, died ten days after giving birth to [her second daughter](https:\/\/en.wikipedia.org\/wiki\/Mary_Shelley \"Mary Shelley\"), who grew up to write *[Frankenstein](https:\/\/en.wikipedia.org\/wiki\/Frankenstein \"Frankenstein\")*. Other notables include African-American poet [Phillis Wheatley](https:\/\/en.wikipedia.org\/wiki\/Phillis_Wheatley \"Phillis Wheatley\") (1784), British housekeeping authority [Isabella Beeton](https:\/\/en.wikipedia.org\/wiki\/Isabella_Beeton \"Isabella Beeton\") (1865),[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-52)[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-53) and American author [Jean Webster](https:\/\/en.wikipedia.org\/wiki\/Jean_Webster \"Jean Webster\") in 1916 died of puerperal fever.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nIn [Charles Dickens](https:\/\/en.wikipedia.org\/wiki\/Charles_Dickens \"Charles Dickens\")' novel *[A Christmas Carol](https:\/\/en.wikipedia.org\/wiki\/A_Christmas_Carol \"A Christmas Carol\")*, it is implied that both [Scrooge's](https:\/\/en.wikipedia.org\/wiki\/Ebenezer_Scrooge \"Ebenezer Scrooge\") mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\].\n\n## See also\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=12 \"Edit section: See also\")\\]\n\n- [Postpartum confinement](https:\/\/en.wikipedia.org\/wiki\/Postpartum_confinement \"Postpartum confinement\"), a traditional practice after childbirth\n\n## References\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=13 \"Edit section: References\")\\]\n\n1. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-8) [***j***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-9) [***k***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-10) [***l***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-11) [***m***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-12) [***n***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-13) [***o***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-14) [***p***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-15) [***q***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-16) [***r***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-17) [***s***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-18) [***t***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-19) [***u***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-20) [***v***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-21)\n   \"37\". *Williams Obstetrics* (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-07-179893-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-07-179893-8 \"Special:BookSources\/978-0-07-179893-8\")\n   \n   .\n2. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-6)\n   [*WHO recommendations for prevention and treatment of maternal peripartum infections*](http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf) (PDF). World Health Organization. 2015. p. 1. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-92-4-154936-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-92-4-154936-3 \"Special:BookSources\/978-92-4-154936-3\")\n   \n   . [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26598777](https:\/\/pubmed.ncbi.nlm.nih.gov\/26598777). [Archived](https:\/\/web.archive.org\/web\/20160207091250\/http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf) (PDF) from the original on 2016-02-07.\n3. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015Pre_3-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015Pre_3-1)\n   GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). [\"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055577). *Lancet*. **388** (10053): 1545–1602\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0140-6736(16)31678-6](https:\/\/doi.org\/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5055577](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055577). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27733282](https:\/\/pubmed.ncbi.nlm.nih.gov\/27733282).\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015De_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015De_4-1)\n   GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). [\"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5388903). *Lancet*. **388** (10053): 1459–1544\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/s0140-6736(16)31012-1](https:\/\/doi.org\/10.1016%2Fs0140-6736%2816%2931012-1). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5388903](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5388903). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27733281](https:\/\/pubmed.ncbi.nlm.nih.gov\/27733281).\n5. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hir2014_5-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hir2014_5-1)\n   Hiralal Konar (2014). [*DC Dutta's Textbook of Obstetrics*](https:\/\/books.google.com\/books?id=LU2VAwAAQBAJ&pg=PA432). JP Medical Ltd. p. 432. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-93-5152-067-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-93-5152-067-2 \"Special:BookSources\/978-93-5152-067-2\")\n   \n   . [Archived](https:\/\/web.archive.org\/web\/20151208041911\/https:\/\/books.google.ca\/books?id=LU2VAwAAQBAJ&pg=PA432) from the original on 2015-12-08.\n6. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hac2015_6-0)**\n   \"Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology\". *Hacker & Moore's essentials of obstetrics and gynecology* (6 ed.). Elsevier Canada. 2015. pp. 276–290\\. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-1-4557-7558-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4557-7558-3 \"Special:BookSources\/978-1-4557-7558-3\")\n   \n   .\n7. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GDB2013_7-0)**\n   GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). [\"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604). *Lancet*. **385** (9963): 117–171\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0140-6736(14)61682-2](https:\/\/doi.org\/10.1016%2FS0140-6736%2814%2961682-2). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [4340604](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [25530442](https:\/\/pubmed.ncbi.nlm.nih.gov\/25530442).\n8. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-8)**\n   Walvekar V (2005). [*Manual of perinatal infections*](https:\/\/books.google.com\/books?id=DIOmY2ROeVAC&pg=PA152). New Delhi: Jaypee Bros. p. 153. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-81-8061-472-9](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-81-8061-472-9 \"Special:BookSources\/978-81-8061-472-9\")\n   \n   . [Archived](https:\/\/web.archive.org\/web\/20160304220030\/https:\/\/books.google.ca\/books?id=DIOmY2ROeVAC&pg=PA152) from the original on 2016-03-04.\n9. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-9)**\n   Magner LN (1992). [*A history of medicine*](https:\/\/archive.org\/details\/historyofmedicin0000magn). New York: Dekker. pp. [257](https:\/\/archive.org\/details\/historyofmedicin0000magn\/page\/257)–258. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-8247-8673-1](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-8247-8673-1 \"Special:BookSources\/978-0-8247-8673-1\")\n   \n   .\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-10)**\n    Anderson BL (April 2014). \"Puerperal group A streptococcal infection: beyond Semmelweis\". *Obstetrics and Gynecology*. **123** (4): 874–882\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/aog.0000000000000175](https:\/\/doi.org\/10.1097%2Faog.0000000000000175). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24785617](https:\/\/pubmed.ncbi.nlm.nih.gov\/24785617). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [24685091](https:\/\/api.semanticscholar.org\/CorpusID:24685091).\n11. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-11)**\n    Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). [\"Medicine in stamps-Ignaz Semmelweis and Puerperal Fever\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3881728). *Journal of the Turkish German Gynecological Association*. **14** (1): 35–9\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.5152\/jtgga.2013.08](https:\/\/doi.org\/10.5152%2Fjtgga.2013.08). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3881728](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3881728). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24592068](https:\/\/pubmed.ncbi.nlm.nih.gov\/24592068).\n12. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-12)**\n    Andy W Wong (2024-03-27). [\"Postpartum Infections\"](https:\/\/emedicine.medscape.com\/article\/796892-overview). *Medscape*. Retrieved 2025-03-14.\n13. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-13)**\n    Befekadu Tesfaye Oyato (2024-06-20). [\"Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC11328626). *BMJ Open*. **14** (6) e083230. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1136\/bmjopen-2023-083230](https:\/\/doi.org\/10.1136%2Fbmjopen-2023-083230). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [11328626](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC11328626). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [38908838](https:\/\/pubmed.ncbi.nlm.nih.gov\/38908838).\n14. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-gfmer.ch_14-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-gfmer.ch_14-1) [The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review](http:\/\/www.gfmer.ch\/Medical_education_En\/PGC_RH_2004\/Pdf\/Chisembele_Puerperal_sepsis.pdf) [Archived](https:\/\/web.archive.org\/web\/20081217023721\/http:\/\/www.gfmer.ch\/Medical_education_En\/PGC_RH_2004\/Pdf\/Chisembele_Puerperal_sepsis.pdf) 2008-12-17 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n15. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-15)** Carter (2005):98\n16. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-16)**\n    Berenson AB (April 1990). [\"Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents\"](http:\/\/journals.lww.com\/greenjournal\/abstract\/1990\/04000\/bacteriologic_findings_of_post_cesarean.12.aspx). *Obstetrics and Gynecology*. **75** (4): 627–629\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [2314783](https:\/\/pubmed.ncbi.nlm.nih.gov\/2314783). [Archived](https:\/\/web.archive.org\/web\/20131103084443\/http:\/\/journals.lww.com\/greenjournal\/abstract\/1990\/04000\/bacteriologic_findings_of_post_cesarean.12.aspx) from the original on 2013-11-03.\n17. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-17)**\n    [\"Atelectasis\"](https:\/\/www.lecturio.com\/concepts\/atelectasis\/). *The Lecturio Medical Concept Library*. Retrieved 7 July 2021.\n18. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-18)**\n    [\"Urinary Tract Infection\"](https:\/\/www.cdc.gov\/getsmart\/community\/for-patients\/common-illnesses\/uti.html). *[Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC)*. 17 April 2015. [Archived](https:\/\/web.archive.org\/web\/20160222034940\/http:\/\/www.cdc.gov\/getsmart\/community\/for-patients\/common-illnesses\/uti.html) from the original on 22 February 2016. Retrieved 7 July 2021.\n19. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-19)**\n    Crum CP, Lee KR, Nucci MR (2011). [*Diagnostic Gynecologic and Obstetric Pathology E-Book*](https:\/\/books.google.com\/books?id=d91mO9WYtPYC&pg=PA430). Elsevier Health Sciences. p. 430. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-1-4557-0895-6](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4557-0895-6 \"Special:BookSources\/978-1-4557-0895-6\")\n    \n    .\n20. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-20)** [Definition of \"infection\" from several medical dictionaries](http:\/\/medical-dictionary.thefreedictionary.com\/infection) – Retrieved on 2021-07-07\n21. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-21)**\n    Callaghan T. *Blueprint Obstetrics and Gynecology*.\n22. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-22)**\n    Berens PD (December 2015). [\"Breast Pain: Engorgement, Nipple Pain, and Mastitis\"](https:\/\/semanticscholar.org\/paper\/a3f96251efd59a92f82ed618dda1fea955027fbe). *Clinical Obstetrics and Gynecology*. **58** (4): 902–14\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/GRF.0000000000000153](https:\/\/doi.org\/10.1097%2FGRF.0000000000000153). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26512442](https:\/\/pubmed.ncbi.nlm.nih.gov\/26512442). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [13006527](https:\/\/api.semanticscholar.org\/CorpusID:13006527).\n23. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-23)**\n    [\"WHO recommendations for prevention and treatment of maternal peripartum infections\"](http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf?ua=1) (PDF). [Archived](https:\/\/web.archive.org\/web\/20160306061338\/http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf?ua=1) (PDF) from the original on 2016-03-06.\n24. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-24)**\n    Carter KC, Carter BR (2005). *Childbed fever. A scientific biography of Ignaz Semmelweis*. Transaction Publishers. p. 100. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-1-4128-0467-7](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4128-0467-7 \"Special:BookSources\/978-1-4128-0467-7\")\n    \n    .\n25. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-25)**\n    [Lewis G](https:\/\/en.wikipedia.org\/wiki\/Gwyneth_Lewis_\\(scientist\\) \"Gwyneth Lewis (scientist)\"), ed. (2007). [*Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom*](http:\/\/www.cemach.org.uk\/getattachment\/8f5c1ed8-fdf3-489b-a182-e53955bec07b\/Saving-Mothers--Lives-2003%E2%80%932005_full.aspx). CEMACH. p. 97. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-9533536-8-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-9533536-8-2 \"Special:BookSources\/978-0-9533536-8-2\")\n    \n    .\n    \n    \\[*[permanent dead link](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot \"Wikipedia:Link rot\")*\\]\n26. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-26)** [CEMACH: Saving Mothers' Lives 2003–2005](http:\/\/www.cemach.org.uk\/Publications\/CEMACH-Publications\/Maternal-and-Perinatal-Health.aspx) [Archived](https:\/\/web.archive.org\/web\/20080521093900\/http:\/\/www.cemach.org.uk\/Publications\/CEMACH-Publications\/Maternal-and-Perinatal-Health.aspx) 2008-05-21 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n27. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-27)**\n    [Loudon I](https:\/\/en.wikipedia.org\/wiki\/Irvine_Loudon \"Irvine Loudon\") (9 March 2000). [*The Tragedy of Childbed Fever*](https:\/\/web.archive.org\/web\/20120211075531\/http:\/\/fds.oup.com\/www.oup.co.uk\/pdf\/0-19-820499-X.pdf) (PDF). Oxford University Press, USA. p. 6. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-19-820499-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-19-820499-2 \"Special:BookSources\/978-0-19-820499-2\")\n    \n    . Archived from [the original](http:\/\/fds.oup.com\/www.oup.co.uk\/pdf\/0-19-820499-X.pdf) (PDF) on 11 February 2012.\n28. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-28)** The debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8.\n29. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-29)**\n    Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). [\"Scarlet fever: a guide for general practitioners\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5649319). *London Journal of Primary Care*. **9** (5): 77–79\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/17571472.2017.1365677](https:\/\/doi.org\/10.1080%2F17571472.2017.1365677). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1757-1472](https:\/\/search.worldcat.org\/issn\/1757-1472). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5649319](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5649319). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [29081840](https:\/\/pubmed.ncbi.nlm.nih.gov\/29081840).\n30. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-30)**\n    Rebecca Davis (2015-01-12). [\"The doctor who championed hand-washing and saved women's lives\"](https:\/\/www.npr.org\/sections\/health-shots\/2015\/01\/12\/375663920\/the-doctor-who-championed-hand-washing-and-saved-women-s-lives). *[National Public Radio](https:\/\/en.wikipedia.org\/wiki\/National_Public_Radio \"National Public Radio\")*. Retrieved 2025-03-14.\n31. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-31)** Loudon I. \"Deaths in childbed from the eighteenth century to 1935\". *Med History* 1986; 30: 1–41\n32. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-32)**\n    Caplan CE (1995). [\"The Childbed Fever Mystery and the Meaning of Medical Journalism\"](https:\/\/web.archive.org\/web\/20120707205101\/http:\/\/www.med.mcgill.ca\/mjm\/issues\/v01n01\/fever.html). *McGill Journal of Medicine*. **1** (1). Archived from [the original](http:\/\/www.med.mcgill.ca\/mjm\/issues\/v01n01\/fever.html) on 2012-07-07.\n33. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Ignaz_Semmelweis_33-0)**\n    Wyklicky H, Skopec M (1983). \"Ignaz Philipp Semmelweis, the prophet of bacteriology\". *Infect Control*. **4** (5): 367–370\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1017\/S0195941700059762](https:\/\/doi.org\/10.1017%2FS0195941700059762). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [6354955](https:\/\/pubmed.ncbi.nlm.nih.gov\/6354955). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [25830725](https:\/\/api.semanticscholar.org\/CorpusID:25830725).\n34. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-childbed_fever_34-0)**\n    De Costa CM (Nov 2002). [\"\"The contagiousness of childbed fever\": a short history of puerperal sepsis and its treatment\"](http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html). *The Medical Journal of Australia*. **177** (11–12\\): 668–671\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.5694\/j.1326-5377.2002.tb05004.x](https:\/\/doi.org\/10.5694%2Fj.1326-5377.2002.tb05004.x). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12463995](https:\/\/pubmed.ncbi.nlm.nih.gov\/12463995). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [12164328](https:\/\/api.semanticscholar.org\/CorpusID:12164328). [Archived](https:\/\/web.archive.org\/web\/20061203030203\/http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html) from the original on 2006-12-03.\n35. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-35)**\n    Gordon A (1795). [*A Treatise on the Epidemic Puerperal Fever of Aberdeen*](https:\/\/archive.org\/details\/treatiseonepidem00gord). London, England: G.G. and J. Robinson. pp. [63](https:\/\/archive.org\/details\/treatiseonepidem00gord\/page\/63)–64.\n    \n    On p. 63, Gordon recognized that puerperal fever was infectious: \"But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted.\" From p. 64: \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"\n36. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Dr_Alexander_Gordon_36-0)**\n    [\"Treatise on the Epidemic of Puerperal Fever\"](https:\/\/web.archive.org\/web\/20080720005441\/http:\/\/www.general-anaesthesia.com\/images\/ignaz-semmelweis.html). www.general-anaesthesia.com. Archived from [the original](https:\/\/www.general-anaesthesia.com\/images\/ignaz-semmelweis.html) on July 20, 2008. Retrieved September 15, 2011.\n37. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-37)**\n    Watson (February 18, 1842). [\"Lectures on the principles and practice of physic: Diseases of the abdomen\"](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015018029671&view=1up&seq=811). *The London Medical Gazette*. **29**: 801–808\\.\n    \n    [From p. 806](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015018029671&view=1up&seq=816): \"Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another.\"\n38. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-38)** [*The Medical Journal of Australia.*\"The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment\"](http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html#i1067496) [Archived](https:\/\/web.archive.org\/web\/20061203030203\/http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html) 2006-12-03 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n39. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-39)**\n    Holmes OW (1842–1843). [\"On the contagiousness of puerperal fever\"](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015059415961&view=1up&seq=513). *The New England Quarterly Journal of Medicine*. **1**: 503–530\\.\n40. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-bartleby.com_40-0)** [Oliver Wendell Holmes: *The Contagiousness of Puerperal Fever*](http:\/\/www.bartleby.com\/38\/5\/1.html) [Archived](https:\/\/web.archive.org\/web\/20070203165344\/http:\/\/www.bartleby.com\/38\/5\/1.html) 2007-02-03 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n41. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-41)** (Holmes, 1842–1843), [p. 510.](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015059415961&view=1up&seq=520)\n42. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-42)**\n    Meigs CD (1854). [*On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class*](https:\/\/archive.org\/details\/onnaturesignstre1854meig). Philadelphia, Pennsylvania: Blanchard and Lea. p. [104](https:\/\/archive.org\/details\/onnaturesignstre1854meig\/page\/104).\n    \n    From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: \"He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean.\"\n43. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GordononMotherhood_43-0)**\n    [Gordon R](https:\/\/en.wikipedia.org\/wiki\/Richard_Gordon_\\(English_author\\) \"Richard Gordon (English author)\") (1983). \"Disastrous Motherhood: Tales from the Vienna Wards\". *Great Medical Disasters*. London: Hutchinson & Co. pp. 43–46 \\[43\\].\n44. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-44)**\n    Treves F (1923). \"Ch. 2: The Old Receiving Room\". [*The Elephant Man and Other Reminiscences*](https:\/\/archive.org\/details\/elephantmanother00trevuoft). London, England: Cassell and Company, Ltd. pp. [56](https:\/\/archive.org\/details\/elephantmanother00trevuoft\/page\/56)–57.\n45. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GordononMotherhood44_45-0)** Gordon, Richard (1983) p. 44\n46. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-raju_46-0)**\n    Raju TN (1999). \"Ignác Semmelweis and the etiology of fetal and neonatal sepsis\". *Journal of Perinatology*. **19** (4): 307–310\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/sj.jp.7200155](https:\/\/doi.org\/10.1038%2Fsj.jp.7200155). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [10685244](https:\/\/pubmed.ncbi.nlm.nih.gov\/10685244). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [29047987](https:\/\/api.semanticscholar.org\/CorpusID:29047987).\n47. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-colyer_47-0)** Christa Colyer.[\"Childbed fever: a nineteenth-century mystery,\"](http:\/\/www.sciencecases.org\/childbed_fever\/childbed_fever.asp) [Archived](https:\/\/web.archive.org\/web\/20090416054052\/http:\/\/www.sciencecases.org\/childbed_fever\/childbed_fever.asp) 2009-04-16 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\") National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003).\n48. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-48)** Colebrook, L; Kenny, M (June 6, 1936). \"Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil\".*Lancet* **227**(1): 1279–1286.\n49. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-49)**\n    Sue Bale, Vanessa Jones (2006). [*Wound care nursing*](https:\/\/books.google.com\/books?id=zbIuXxpoRXMC&q=fireguards+act+1952&pg=PA54). Elsevier Health Sciences. p. 54. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-7234-3344-6](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7234-3344-6 \"Special:BookSources\/978-0-7234-3344-6\")\n    \n    . Retrieved 2009-08-05.\n50. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-50)**\n    Sophie Campbell (2012-08-14). [\"Sudeley Castle: the curious life and death of Katherine Parr\"](https:\/\/www.telegraph.co.uk\/travel\/destinations\/europe\/united-kingdom\/england\/cotswolds\/articles\/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr\/). *The Telegraph*. Retrieved 2025-03-14.\n51. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-51)** Quoted from [Will Durant](https:\/\/en.wikipedia.org\/wiki\/Will_Durant \"Will Durant\")'s \"The Age of Rousseau\".\\[*[full citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources#What_information_to_include \"Wikipedia:Citing sources\")*\\]\n52. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-52)**\n    Beetham M (2004). [\"Beeton, Samuel Orchart (1831–1877)\"](http:\/\/www.oxforddnb.com\/view\/article\/45481). *[Oxford Dictionary of National Biography](https:\/\/en.wikipedia.org\/wiki\/Dictionary_of_National_Biography#Oxford_Dictionary_of_National_Biography \"Dictionary of National Biography\")* (online ed.). Oxford University Press. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1093\/ref:odnb\/45481](https:\/\/doi.org\/10.1093%2Fref%3Aodnb%2F45481). Retrieved 23 November 2015.\n    \n    `{{cite encyclopedia}}`: CS1 maint: ref duplicates default ([link](https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_ref_duplicates_default \"Category:CS1 maint: ref duplicates default\")) (Subscription, [Wikipedia Library](https:\/\/wikipedialibrary.wmflabs.org\/partners\/88\/) access or [UK public library membership](https:\/\/www.oxforddnb.com\/help\/subscribe#public) required.)\n53. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-53)**\n    [Hughes K](https:\/\/en.wikipedia.org\/wiki\/Kathryn_Hughes \"Kathryn Hughes\") (2006). [*The Short Life and Long Times of Mrs Beeton*](https:\/\/books.google.com\/books?id=p5NvuLMB3tYC&pg=PP1). London: HarperCollins Publishers. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-7524-6122-9](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7524-6122-9 \"Special:BookSources\/978-0-7524-6122-9\")\n    \n    .\n\n## Further reading\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=14 \"Edit section: Further reading\")\\]\n\n- Chaim W, Burstein E (August 2003). \"Postpartum infection treatments: a review\". *Expert Opinion on Pharmacotherapy* (review). **4** (8): 1297–313\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1517\/14656566.4.8.1297](https:\/\/doi.org\/10.1517%2F14656566.4.8.1297). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12877638](https:\/\/pubmed.ncbi.nlm.nih.gov\/12877638). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [26781321](https:\/\/api.semanticscholar.org\/CorpusID:26781321).\n- French L (August 2003). \"Prevention and treatment of postpartum endometritis\". *Current Women's Health Reports* (review). **3** (4): 274–9\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12844449](https:\/\/pubmed.ncbi.nlm.nih.gov\/12844449).\n- Calhoun BC, Brost B (June 1995). \"Emergency management of sudden puerperal fever\". *Obstetrics and Gynecology Clinics of North America* (review). **22** (2): 357–67\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0889-8545(21)00185-6](https:\/\/doi.org\/10.1016%2FS0889-8545%2821%2900185-6). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [7651676](https:\/\/pubmed.ncbi.nlm.nih.gov\/7651676).\n\n## External links\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=15 \"Edit section: External links\")\\]\n\n|   |   |\n|---|---|\n| Classification | [D](https:\/\/www.wikidata.org\/wiki\/Q1419347 \"d:Q1419347\") **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[10](https:\/\/en.wikipedia.org\/wiki\/ICD-10 \"ICD-10\")**: [O85](https:\/\/icd.who.int\/browse10\/2019\/en#\/O85) **[ICD](https:\/\/en.wikipedia.org\/wiki\/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems \"International Statistical Classification of Diseases and Related Health Problems\")\\-[9-CM](https:\/\/en.wikipedia.org\/wiki\/List_of_ICD-9_codes \"List of ICD-9 codes\")**: [672](http:\/\/www.icd9data.com\/getICD9Code.ashx?icd9=672) **[MeSH](https:\/\/en.wikipedia.org\/wiki\/Medical_Subject_Headings \"Medical Subject Headings\")**: [D011645](https:\/\/meshb.nlm.nih.gov\/record\/ui?ui=D011645) |\n| External resources | **[eMedicine](https:\/\/en.wikipedia.org\/wiki\/EMedicine \"EMedicine\")**: [article\/796892](https:\/\/emedicine.medscape.com\/article\/796892-overview) |\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:Pathology_of_pregnancy,_childbirth,_and_the_puerperium \"Template:Pathology of pregnancy, childbirth, and the puerperium\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:Pathology_of_pregnancy,_childbirth,_and_the_puerperium \"Template talk:Pathology of pregnancy, childbirth, and the puerperium\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:Pathology_of_pregnancy,_childbirth,_and_the_puerperium \"Special:EditPage\/Template:Pathology of pregnancy, childbirth, and the puerperium\")Pathology of [pregnancy](https:\/\/en.wikipedia.org\/wiki\/Pregnancy \"Pregnancy\"), [childbirth](https:\/\/en.wikipedia.org\/wiki\/Childbirth \"Childbirth\"), and the [puerperium](https:\/\/en.wikipedia.org\/wiki\/Postpartum_period \"Postpartum period\") |   |\n|---|---|\n| [Pregnancy](https:\/\/en.wikipedia.org\/wiki\/Complications_of_pregnancy \"Complications of pregnancy\") |   |\n|   |   |\n| [Pregnancy with abortive outcome](https:\/\/en.wikipedia.org\/wiki\/Pregnancy_with_abortive_outcome \"Pregnancy with abortive outcome\") | [Abortion](https:\/\/en.wikipedia.org\/wiki\/Abortion \"Abortion\") [Ectopic pregnancy](https:\/\/en.wikipedia.org\/wiki\/Ectopic_pregnancy \"Ectopic pregnancy\") [Abdominal](https:\/\/en.wikipedia.org\/wiki\/Abdominal_pregnancy \"Abdominal pregnancy\") [Cervical](https:\/\/en.wikipedia.org\/wiki\/Cervical_pregnancy \"Cervical pregnancy\") [Heterotopic](https:\/\/en.wikipedia.org\/wiki\/Heterotopic_pregnancy \"Heterotopic pregnancy\") [Interstitial](https:\/\/en.wikipedia.org\/wiki\/Interstitial_pregnancy \"Interstitial pregnancy\") [Ovarian](https:\/\/en.wikipedia.org\/wiki\/Ovarian_pregnancy \"Ovarian pregnancy\") [Rudimentary horn](https:\/\/en.wikipedia.org\/wiki\/Rudimentary_horn_pregnancy \"Rudimentary horn pregnancy\") [Embryo loss](https:\/\/en.wikipedia.org\/wiki\/Embryo_loss \"Embryo loss\") [Fetal resorption](https:\/\/en.wikipedia.org\/wiki\/Fetal_resorption \"Fetal resorption\") [Molar pregnancy](https:\/\/en.wikipedia.org\/wiki\/Molar_pregnancy \"Molar pregnancy\") [Miscarriage](https:\/\/en.wikipedia.org\/wiki\/Miscarriage \"Miscarriage\") [Stillbirth](https:\/\/en.wikipedia.org\/wiki\/Stillbirth \"Stillbirth\") |\n| [Edema](https:\/\/en.wikipedia.org\/wiki\/Edema \"Edema\"), [proteinuria](https:\/\/en.wikipedia.org\/wiki\/Proteinuria \"Proteinuria\"), and [hypertensive disorders](https:\/\/en.wikipedia.org\/wiki\/Hypertensive_disease_of_pregnancy \"Hypertensive disease of pregnancy\") | [Gestational hypertension](https:\/\/en.wikipedia.org\/wiki\/Gestational_hypertension \"Gestational hypertension\") [Pre-eclampsia](https:\/\/en.wikipedia.org\/wiki\/Pre-eclampsia \"Pre-eclampsia\") [HELLP syndrome](https:\/\/en.wikipedia.org\/wiki\/HELLP_syndrome \"HELLP syndrome\") [Eclampsia](https:\/\/en.wikipedia.org\/wiki\/Eclampsia \"Eclampsia\") |\n| Other, predominantly  related to pregnancy |   |\n|   |   |\n| [Digestive system](https:\/\/en.wikipedia.org\/wiki\/Human_digestive_system \"Human digestive system\") | [Acute fatty liver of pregnancy](https:\/\/en.wikipedia.org\/wiki\/Acute_fatty_liver_of_pregnancy \"Acute fatty liver of pregnancy\") [Gestational diabetes](https:\/\/en.wikipedia.org\/wiki\/Gestational_diabetes \"Gestational diabetes\") [Hepatitis E](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_E \"Hepatitis E\") [Hyperemesis gravidarum](https:\/\/en.wikipedia.org\/wiki\/Hyperemesis_gravidarum \"Hyperemesis gravidarum\") [Intrahepatic cholestasis of pregnancy](https:\/\/en.wikipedia.org\/wiki\/Intrahepatic_cholestasis_of_pregnancy \"Intrahepatic cholestasis of pregnancy\") |\n| [Integumentary system](https:\/\/en.wikipedia.org\/wiki\/Integumentary_system \"Integumentary system\") \/  [dermatoses of pregnancy](https:\/\/en.wikipedia.org\/wiki\/Dermatoses_of_pregnancy \"Dermatoses of pregnancy\") | [Gestational pemphigoid](https:\/\/en.wikipedia.org\/wiki\/Gestational_pemphigoid \"Gestational pemphigoid\") [Impetigo herpetiformis](https:\/\/en.wikipedia.org\/wiki\/Impetigo_herpetiformis \"Impetigo herpetiformis\") [Intrahepatic cholestasis of pregnancy](https:\/\/en.wikipedia.org\/wiki\/Intrahepatic_cholestasis_of_pregnancy \"Intrahepatic cholestasis of pregnancy\") [Linea nigra](https:\/\/en.wikipedia.org\/wiki\/Linea_nigra \"Linea nigra\") [Prurigo gestationis](https:\/\/en.wikipedia.org\/wiki\/Prurigo_gestationis \"Prurigo gestationis\") [Pruritic folliculitis of pregnancy](https:\/\/en.wikipedia.org\/wiki\/Pruritic_folliculitis_of_pregnancy \"Pruritic folliculitis of pregnancy\") [Pruritic urticarial papules and plaques of pregnancy (PUPPP)](https:\/\/en.wikipedia.org\/wiki\/Pruritic_urticarial_papules_and_plaques_of_pregnancy \"Pruritic urticarial papules and plaques of pregnancy\") [Stretch marks](https:\/\/en.wikipedia.org\/wiki\/Stretch_marks \"Stretch marks\") |\n| [Nervous system](https:\/\/en.wikipedia.org\/wiki\/Nervous_system \"Nervous system\") | [Chorea gravidarum](https:\/\/en.wikipedia.org\/wiki\/Chorea_gravidarum \"Chorea gravidarum\") |\n| [Blood](https:\/\/en.wikipedia.org\/wiki\/Blood \"Blood\") | [Gestational thrombocytopenia](https:\/\/en.wikipedia.org\/wiki\/Gestational_thrombocytopenia \"Gestational thrombocytopenia\") [Pregnancy-induced hypercoagulability](https:\/\/en.wikipedia.org\/wiki\/Hypercoagulability_in_pregnancy \"Hypercoagulability in pregnancy\") |\n| Maternal care related to the  [fetus](https:\/\/en.wikipedia.org\/wiki\/Fetus \"Fetus\") and [amniotic cavity](https:\/\/en.wikipedia.org\/wiki\/Amniotic_cavity \"Amniotic cavity\") | *[amniotic fluid](https:\/\/en.wikipedia.org\/wiki\/Amniotic_fluid \"Amniotic fluid\")* [Oligohydramnios](https:\/\/en.wikipedia.org\/wiki\/Oligohydramnios \"Oligohydramnios\") [Polyhydramnios](https:\/\/en.wikipedia.org\/wiki\/Polyhydramnios \"Polyhydramnios\") [Braxton Hicks contractions](https:\/\/en.wikipedia.org\/wiki\/Braxton_Hicks_contractions \"Braxton Hicks contractions\") *[chorion](https:\/\/en.wikipedia.org\/wiki\/Chorion \"Chorion\") \/ [amnion](https:\/\/en.wikipedia.org\/wiki\/Amnion \"Amnion\")* [Chorioamnionitis](https:\/\/en.wikipedia.org\/wiki\/Chorioamnionitis \"Chorioamnionitis\") [Chorionic hematoma](https:\/\/en.wikipedia.org\/wiki\/Chorionic_hematoma \"Chorionic hematoma\") [Constriction ring syndrome](https:\/\/en.wikipedia.org\/wiki\/Constriction_ring_syndrome \"Constriction ring syndrome\") [Monoamniotic twins](https:\/\/en.wikipedia.org\/wiki\/Monoamniotic_twins \"Monoamniotic twins\") [Prelabor rupture of membranes](https:\/\/en.wikipedia.org\/wiki\/Prelabor_rupture_of_membranes \"Prelabor rupture of membranes\") [Obstetrical bleeding](https:\/\/en.wikipedia.org\/wiki\/Obstetrical_bleeding \"Obstetrical bleeding\") [Antepartum](https:\/\/en.wikipedia.org\/wiki\/Antepartum_bleeding \"Antepartum bleeding\") *[placenta](https:\/\/en.wikipedia.org\/wiki\/Placental_disease \"Placental disease\")* [Circumvallate placenta](https:\/\/en.wikipedia.org\/wiki\/Circumvallate_placenta \"Circumvallate placenta\") [Monochorionic twins](https:\/\/en.wikipedia.org\/wiki\/Monochorionic_twins \"Monochorionic twins\") [Placenta accreta](https:\/\/en.wikipedia.org\/wiki\/Placenta_accreta_spectrum \"Placenta accreta spectrum\") [Placenta praevia](https:\/\/en.wikipedia.org\/wiki\/Placenta_praevia \"Placenta praevia\") [Placental abruption](https:\/\/en.wikipedia.org\/wiki\/Placental_abruption \"Placental abruption\") [Twin-to-twin transfusion syndrome](https:\/\/en.wikipedia.org\/wiki\/Twin-to-twin_transfusion_syndrome \"Twin-to-twin transfusion syndrome\") |\n| [Labor](https:\/\/en.wikipedia.org\/wiki\/Obstetric_labor_complication \"Obstetric labor complication\") | [Amniotic fluid embolism](https:\/\/en.wikipedia.org\/wiki\/Amniotic_fluid_embolism \"Amniotic fluid embolism\") [Cephalopelvic disproportion](https:\/\/en.wikipedia.org\/wiki\/Cephalopelvic_disproportion \"Cephalopelvic disproportion\") [Obstructed labour](https:\/\/en.wikipedia.org\/wiki\/Obstructed_labour \"Obstructed labour\") [Shoulder dystocia](https:\/\/en.wikipedia.org\/wiki\/Shoulder_dystocia \"Shoulder dystocia\") [Fetal distress](https:\/\/en.wikipedia.org\/wiki\/Fetal_distress \"Fetal distress\") [Locked twins](https:\/\/en.wikipedia.org\/wiki\/Locked_twins \"Locked twins\") [Nuchal cord](https:\/\/en.wikipedia.org\/wiki\/Nuchal_cord \"Nuchal cord\") [Obstetrical bleeding](https:\/\/en.wikipedia.org\/wiki\/Obstetrical_bleeding \"Obstetrical bleeding\") [Postpartum](https:\/\/en.wikipedia.org\/wiki\/Postpartum_bleeding \"Postpartum bleeding\") [Pain management during childbirth](https:\/\/en.wikipedia.org\/wiki\/Pain_management_during_childbirth \"Pain management during childbirth\") *[placenta](https:\/\/en.wikipedia.org\/wiki\/Placental_disease \"Placental disease\")* [Placenta accreta](https:\/\/en.wikipedia.org\/wiki\/Placenta_accreta_spectrum \"Placenta accreta spectrum\") [Preterm birth](https:\/\/en.wikipedia.org\/wiki\/Preterm_birth \"Preterm birth\") [Postmature birth](https:\/\/en.wikipedia.org\/wiki\/Postterm_pregnancy \"Postterm pregnancy\") [Umbilical cord prolapse](https:\/\/en.wikipedia.org\/wiki\/Umbilical_cord_prolapse \"Umbilical cord prolapse\") [Uterine inversion](https:\/\/en.wikipedia.org\/wiki\/Uterine_inversion \"Uterine inversion\") [Uterine rupture](https:\/\/en.wikipedia.org\/wiki\/Uterine_rupture \"Uterine rupture\") [Vasa praevia](https:\/\/en.wikipedia.org\/wiki\/Vasa_praevia \"Vasa praevia\") [Uterine atony](https:\/\/en.wikipedia.org\/wiki\/Uterine_atony \"Uterine atony\") |\n| [Puerperal](https:\/\/en.wikipedia.org\/wiki\/Puerperal_disorder \"Puerperal disorder\") | [Breastfeeding difficulties](https:\/\/en.wikipedia.org\/wiki\/Breastfeeding_difficulties \"Breastfeeding difficulties\") [Low milk supply](https:\/\/en.wikipedia.org\/wiki\/Low_milk_supply \"Low milk supply\") [Cracked nipples](https:\/\/en.wikipedia.org\/wiki\/Cracked_nipple \"Cracked nipple\") [Breast engorgement](https:\/\/en.wikipedia.org\/wiki\/Breast_engorgement \"Breast engorgement\") [Childbirth-related post-traumatic stress disorder](https:\/\/en.wikipedia.org\/wiki\/Childbirth-related_post-traumatic_stress_disorder \"Childbirth-related post-traumatic stress disorder\") [Pubic symphysis diastasis](https:\/\/en.wikipedia.org\/wiki\/Pubic_symphysis_diastasis \"Pubic symphysis diastasis\") [Postpartum bleeding](https:\/\/en.wikipedia.org\/wiki\/Postpartum_bleeding \"Postpartum bleeding\") [Peripartum cardiomyopathy](https:\/\/en.wikipedia.org\/wiki\/Peripartum_cardiomyopathy \"Peripartum cardiomyopathy\") [Postpartum depression](https:\/\/en.wikipedia.org\/wiki\/Postpartum_depression \"Postpartum depression\") [Postpartum infections]() [Postpartum psychosis](https:\/\/en.wikipedia.org\/wiki\/Postpartum_psychosis \"Postpartum psychosis\") [Postpartum thyroiditis](https:\/\/en.wikipedia.org\/wiki\/Postpartum_thyroiditis \"Postpartum thyroiditis\") [Puerperal mastitis](https:\/\/en.wikipedia.org\/wiki\/Puerperal_mastitis \"Puerperal mastitis\") |\n| Other | [Concomitant conditions](https:\/\/en.wikipedia.org\/wiki\/Pre-existing_disease_in_pregnancy \"Pre-existing disease in pregnancy\") [Diabetes 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Wikipedia® is a registered trademark of the [Wikimedia Foundation, Inc.](https:\/\/wikimediafoundation.org\/), a non-profit organization.\n\n- [Privacy policy](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Privacy_policy)\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About)\n- [Disclaimers](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:General_disclaimer)\n- [Contact Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us)\n- [Legal & safety contacts](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Legal:Wikimedia_Foundation_Legal_and_Safety_Contact_Information)\n- [Code of Conduct](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Universal_Code_of_Conduct)\n- [Developers](https:\/\/developer.wikimedia.org\/)\n- [Statistics](https:\/\/stats.wikimedia.org\/#\/en.wikipedia.org)\n- [Cookie statement](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Cookie_statement)\n- [Mobile 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\"Streptococcus pyogenes\")* (red-stained spheres) is responsible for many cases of severe puerperal fever. |   |\n| [Specialty](https:\/\/en.wikipedia.org\/wiki\/Medical_specialty \"Medical specialty\") | [Obstetrics](https:\/\/en.wikipedia.org\/wiki\/Obstetrics \"Obstetrics\") |\n| [Symptoms](https:\/\/en.wikipedia.org\/wiki\/Signs_and_symptoms \"Signs and symptoms\") | Fever, lower abdominal pain, bad-smelling vaginal discharge[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| [Causes](https:\/\/en.wikipedia.org\/wiki\/Cause_\\(medicine\\) \"Cause (medicine)\") | Typically multiple types of bacteria[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| [Risk factors](https:\/\/en.wikipedia.org\/wiki\/Risk_factor \"Risk factor\") | [Caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\"), [premature rupture of membranes](https:\/\/en.wikipedia.org\/wiki\/Premature_rupture_of_membranes \"Premature rupture of membranes\"), [prolonged labour](https:\/\/en.wikipedia.org\/wiki\/Prolonged_labour \"Prolonged labour\"), [malnutrition](https:\/\/en.wikipedia.org\/wiki\/Malnutrition \"Malnutrition\"), [diabetes](https:\/\/en.wikipedia.org\/wiki\/Diabetes \"Diabetes\")[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) |\n| Treatment | [Antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotics \"Antibiotics\")[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) |\n| Frequency | 11\\.8 million[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015Pre-3) |\n| Deaths | 17,900[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015De-4) |\n\n**Postpartum infections**, also known as **childbed fever** and **puerperal fever**, are any bacterial [infections](https:\/\/en.wikipedia.org\/wiki\/Infection \"Infection\") of the [female reproductive tract](https:\/\/en.wikipedia.org\/wiki\/Female_reproductive_tract \"Female reproductive tract\") following [childbirth](https:\/\/en.wikipedia.org\/wiki\/Childbirth \"Childbirth\") or [miscarriage](https:\/\/en.wikipedia.org\/wiki\/Miscarriage \"Miscarriage\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Signs and symptoms usually include a [fever](https:\/\/en.wikipedia.org\/wiki\/Fever \"Fever\") greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous [vaginal discharge](https:\/\/en.wikipedia.org\/wiki\/Vaginal_discharge \"Vaginal discharge\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hir2014-5)\n\nThe most common infection is that of the [uterus](https:\/\/en.wikipedia.org\/wiki\/Uterus \"Uterus\") and surrounding tissues known as **puerperal sepsis**, **postpartum metritis**, or **postpartum endometritis**.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hac2015-6) Risk factors include [caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\") (C-section), the presence of certain bacteria such as [group B streptococcus](https:\/\/en.wikipedia.org\/wiki\/Group_B_streptococcus \"Group B streptococcus\") in the vagina, [premature rupture of membranes](https:\/\/en.wikipedia.org\/wiki\/Premature_rupture_of_membranes \"Premature rupture of membranes\"), multiple [vaginal exams](https:\/\/en.wikipedia.org\/wiki\/Vaginal_exam \"Vaginal exam\"), manual removal of the [placenta](https:\/\/en.wikipedia.org\/wiki\/Placenta \"Placenta\"), and [prolonged labour](https:\/\/en.wikipedia.org\/wiki\/Prolonged_labour \"Prolonged labour\") among others.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) Most infections involve a number of types of bacteria.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Diagnosis is rarely helped by [culturing](https:\/\/en.wikipedia.org\/wiki\/Microbiological_culture \"Microbiological culture\") of the vagina or blood.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those who do not improve, [medical imaging](https:\/\/en.wikipedia.org\/wiki\/Medical_imaging \"Medical imaging\") may be required.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Other causes of fever following delivery include [breast engorgement](https:\/\/en.wikipedia.org\/wiki\/Breast_engorgement \"Breast engorgement\"), [urinary tract infections](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"), infections of an abdominal incision or an [episiotomy](https:\/\/en.wikipedia.org\/wiki\/Episiotomy \"Episiotomy\"), and [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)\n\nDue to the risks following caesarean section, it is recommended that all women receive a preventive dose of [antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotic \"Antibiotic\") such as [ampicillin](https:\/\/en.wikipedia.org\/wiki\/Ampicillin \"Ampicillin\") around the time of surgery.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Treatment of established infections is with antibiotics, with most people improving in two to three days.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those with mild disease, oral antibiotics may be used; otherwise, [intravenous](https:\/\/en.wikipedia.org\/wiki\/Intravenous \"Intravenous\") antibiotics are recommended.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) Common antibiotics include a combination of ampicillin and [gentamicin](https:\/\/en.wikipedia.org\/wiki\/Gentamicin \"Gentamicin\") following vaginal delivery or [clindamycin](https:\/\/en.wikipedia.org\/wiki\/Clindamycin \"Clindamycin\") and gentamicin in those who have had a C-section.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In those who are not improving with appropriate treatment, other complications such as an [abscess](https:\/\/en.wikipedia.org\/wiki\/Abscess \"Abscess\") should be considered.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\nIn 2015, about 11.8 million maternal infections occurred.[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015Pre-3) In the developed world about 1% to 2% develop uterine infections following [vaginal delivery](https:\/\/en.wikipedia.org\/wiki\/Vaginal_delivery \"Vaginal delivery\").[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GBD2015De-4)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GDB2013-7) They are the cause of about 10% of deaths around the time of pregnancy.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) The first known descriptions of the condition date back to at least the 5th century BCE in the writings of [Hippocrates](https:\/\/en.wikipedia.org\/wiki\/Hippocrates \"Hippocrates\").[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-8) These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-9) In 1847, Hungarian physician [Ignaz Semmelweiss](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweiss \"Ignaz Semmelweiss\") decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of [handwashing](https:\/\/en.wikipedia.org\/wiki\/Handwashing \"Handwashing\") with [calcium hypochlorite](https:\/\/en.wikipedia.org\/wiki\/Calcium_hypochlorite \"Calcium hypochlorite\").[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-10)[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-11)\n\nSigns and symptoms usually include a [fever](https:\/\/en.wikipedia.org\/wiki\/Fever \"Fever\") greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Hir2014-5)\n\nAfter childbirth, the [female genital tract](https:\/\/en.wikipedia.org\/wiki\/Female_reproductive_system \"Female reproductive system\") has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the [uterus](https:\/\/en.wikipedia.org\/wiki\/Uterus \"Uterus\"), or it may spread beyond to cause [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\") or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the [placenta](https:\/\/en.wikipedia.org\/wiki\/Placenta \"Placenta\") (afterbirth), but [pathogenic](https:\/\/en.wikipedia.org\/wiki\/Pathogenic \"Pathogenic\") organisms may also affect [lacerations](https:\/\/en.wikipedia.org\/wiki\/Lacerations \"Lacerations\") of any part of the genital tract. By whatever portal, they can invade the [bloodstream](https:\/\/en.wikipedia.org\/wiki\/Bloodstream \"Bloodstream\") and [lymph system](https:\/\/en.wikipedia.org\/wiki\/Lymph_system \"Lymph system\") to cause [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\"), [cellulitis](https:\/\/en.wikipedia.org\/wiki\/Cellulitis \"Cellulitis\") (inflammation of connective tissue), and pelvic or generalized [peritonitis](https:\/\/en.wikipedia.org\/wiki\/Peritonitis \"Peritonitis\") (inflammation of the abdominal lining). The severity of the illness depends on the [virulence](https:\/\/en.wikipedia.org\/wiki\/Virulence \"Virulence\") of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are *[Streptococcus pyogenes](https:\/\/en.wikipedia.org\/wiki\/Streptococcus_pyogenes \"Streptococcus pyogenes\")*; [staphylococci](https:\/\/en.wikipedia.org\/wiki\/Staphylococci \"Staphylococci\") (inhabitants of the skin and of [pimples](https:\/\/en.wikipedia.org\/wiki\/Pimples \"Pimples\"), [carbuncles](https:\/\/en.wikipedia.org\/wiki\/Carbuncles \"Carbuncles\"), and many other [pustular](https:\/\/en.wikipedia.org\/wiki\/Pustular \"Pustular\") eruptions); the [anaerobic streptococci](https:\/\/en.wikipedia.org\/wiki\/Peptostreptococcus \"Peptostreptococcus\"), which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; *[Escherichia coli](https:\/\/en.wikipedia.org\/wiki\/Escherichia_coli \"Escherichia coli\")*[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-12) and *[Clostridium perfringens](https:\/\/en.wikipedia.org\/wiki\/Clostridium_perfringens \"Clostridium perfringens\")* (inhabitants of the lower bowel); and *[Clostridium tetani](https:\/\/en.wikipedia.org\/wiki\/Clostridium_tetani \"Clostridium tetani\")*.[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-13)\n\nCauses (listed in order of decreasing frequency) include: [endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\"), [urinary tract infection](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"), [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\")\/[atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"), [wound infection](https:\/\/en.wikipedia.org\/wiki\/Wound_infection \"Wound infection\"), and [septic pelvic thrombophlebitis](https:\/\/en.wikipedia.org\/wiki\/Septic_pelvic_thrombophlebitis \"Septic pelvic thrombophlebitis\"). Sepsis risk factors for each condition are listed in order of the [postpartum](https:\/\/en.wikipedia.org\/wiki\/Postpartum \"Postpartum\") day (PPD) on which the condition generally occurs.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\n- PPD 0: [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\") risk factors include [general anesthesia](https:\/\/en.wikipedia.org\/wiki\/General_anesthesia \"General anesthesia\"), [cigarette smoking](https:\/\/en.wikipedia.org\/wiki\/Cigarette_smoking \"Cigarette smoking\"), and [obstructive lung disease](https:\/\/en.wikipedia.org\/wiki\/Obstructive_lung_disease \"Obstructive lung disease\").\n- PPD 1–2: urinary tract infection risk factors include multiple [catheterization](https:\/\/en.wikipedia.org\/wiki\/Catheterization \"Catheterization\") during labor, multiple [vaginal examinations](https:\/\/en.wikipedia.org\/wiki\/Vaginal_examination \"Vaginal examination\") during labor, and untreated [bacteriuria](https:\/\/en.wikipedia.org\/wiki\/Bacteriuria \"Bacteriuria\").\n- PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor.\n- PPD 4–5: wound infection risk factors include emergency [cesarean section](https:\/\/en.wikipedia.org\/wiki\/Cesarean_section \"Cesarean section\"), prolonged [membrane rupture](https:\/\/en.wikipedia.org\/wiki\/Membrane_rupture \"Membrane rupture\"), prolonged labor, and multiple vaginal examinations during labor.\n- PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth.\n- PPD 7–21: [mastitis](https:\/\/en.wikipedia.org\/wiki\/Mastitis \"Mastitis\") risk factors include nipple trauma from [breastfeeding](https:\/\/en.wikipedia.org\/wiki\/Breastfeeding \"Breastfeeding\").\n\nPuerperal fever is diagnosed with:\n\n- A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10)\n- Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-gfmer.ch-14)\n\nPuerperal fever (from the Latin *puer*, *male child (boy)*), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-15)\n\n1. the specific target of infection: [endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\") (inflammation of the inner lining of the uterus), [metrophlebitis](https:\/\/en.wikipedia.org\/w\/index.php?title=Metrophlebitis&action=edit&redlink=1 \"Metrophlebitis (page does not exist)\") (inflammation of the veins of the uterus), and [peritonitis](https:\/\/en.wikipedia.org\/wiki\/Peritonitis \"Peritonitis\") (inflammation of the membrane lining of the abdomen).\n2. the severity of the infection: less serious [infection](https:\/\/en.wikipedia.org\/wiki\/Infection \"Infection\") (contained multiplication of microbes) or possibly life-threatening [sepsis](https:\/\/en.wikipedia.org\/wiki\/Sepsis \"Sepsis\") (uncontrolled and uncontained multiplication of microbes throughout the bloodstream).\n\n[Endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\") is a polymicrobial infection. It frequently includes organisms such as *[Ureaplasma](https:\/\/en.wikipedia.org\/wiki\/Ureaplasma \"Ureaplasma\")*, *[Streptococcus](https:\/\/en.wikipedia.org\/wiki\/Streptococcus \"Streptococcus\")*, *[Mycoplasma](https:\/\/en.wikipedia.org\/wiki\/Mycoplasma \"Mycoplasma\")*, and *[Bacteroides](https:\/\/en.wikipedia.org\/wiki\/Bacteroides \"Bacteroides\")*, and may also include organisms such as *[Gardnerella](https:\/\/en.wikipedia.org\/wiki\/Gardnerella \"Gardnerella\")*, *[Chlamydia](https:\/\/en.wikipedia.org\/wiki\/Chlamydia_\\(bacterium\\) \"Chlamydia (bacterium)\")*, *[Lactobacillus](https:\/\/en.wikipedia.org\/wiki\/Lactobacillus \"Lactobacillus\")*, *[Escherichia](https:\/\/en.wikipedia.org\/wiki\/Escherichia \"Escherichia\")*, and *[Staphylococcus](https:\/\/en.wikipedia.org\/wiki\/Staphylococcus \"Staphylococcus\")*.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-16)\n\n### Differential diagnosis\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=5 \"Edit section: Differential diagnosis\")\\]\n\nSeveral other conditions can cause fevers following delivery, including: [urinary tract infections](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infections \"Urinary tract infections\"), [breast engorgement](https:\/\/en.wikipedia.org\/wiki\/Breast_engorgement \"Breast engorgement\"), [atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"), and surgical incisions, among others.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\nAntibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2) It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)\n\n[Atelectasis](https:\/\/en.wikipedia.org\/wiki\/Atelectasis \"Atelectasis\"): mild to moderate fever, no changes or mild rales on chest [auscultation](https:\/\/en.wikipedia.org\/wiki\/Auscultation \"Auscultation\").[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-17)\n\nManagement: pulmonary exercises, ambulation (deep breathing and walking).\n\n[Urinary tract infection](https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection \"Urinary tract infection\"): high fever, malaise, [costovertebral](https:\/\/en.wikipedia.org\/wiki\/Costovertebral_angle_tenderness \"Costovertebral angle tenderness\") tenderness, positive urine culture.[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-18)\n\nManagement: antibiotics as per culture sensitivity (cephalosporin).\n\n[Endometritis](https:\/\/en.wikipedia.org\/wiki\/Endometritis \"Endometritis\"): moderate fever, exquisite uterine tenderness, minimal abdominal findings.[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-19)\n\nManagement: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary.\n\n[Wound infection](https:\/\/en.wikipedia.org\/wiki\/Wound_infection \"Wound infection\"): persistent spiking fever despite antibiotics, wound [erythema](https:\/\/en.wikipedia.org\/wiki\/Erythema \"Erythema\") or fluctuance, wound drainage.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-20)\n\nManagement: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure.\n\n[Septic pelvic thrombophlebitis](https:\/\/en.wikipedia.org\/wiki\/Septic_pelvic_thrombophlebitis \"Septic pelvic thrombophlebitis\"): persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-21)\n\nManagement: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values.\n\n[Mastitis](https:\/\/en.wikipedia.org\/wiki\/Mastitis \"Mastitis\"): unilateral, localized erythema, [edema](https:\/\/en.wikipedia.org\/wiki\/Edema \"Edema\"), tenderness.[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-22)\n\nManagement: antibiotics for cellulitis, open and drain the abscess if present.\n\nThe number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-gfmer.ch-14) Globally, bacterial infections are the cause of 10% of [maternal deaths](https:\/\/en.wikipedia.org\/wiki\/Maternal_death \"Maternal death\")—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-WHOBook2015-2)[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-23)\n\nIn the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is [caesarean section](https:\/\/en.wikipedia.org\/wiki\/Caesarean_section \"Caesarean section\").[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-24) The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-W2014-1)\n\nIn the United Kingdom from 1985 to 2005, the number of *direct* deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-25) In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-26)\n\nPuerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to [childbirth](https:\/\/en.wikipedia.org\/wiki\/Childbirth \"Childbirth\"), and was second only to [tuberculosis](https:\/\/en.wikipedia.org\/wiki\/Tuberculosis \"Tuberculosis\") in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-27)\n\nAlthough it had been recognized from as early as the time of the [Hippocratic corpus](https:\/\/en.wikipedia.org\/wiki\/Hippocratic_corpus \"Hippocratic corpus\") that women in childbed were prone to fevers, the distinct name \"puerperal fever\" appears in historical records only from the early 18th century.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-28)\n\nThe death rate for women giving birth decreased in the 20th century in [developed countries](https:\/\/en.wikipedia.org\/wiki\/Developed_countries \"Developed countries\"). The decline may be partly attributed to improved environmental conditions, better [obstetrical](https:\/\/en.wikipedia.org\/wiki\/Obstetrical \"Obstetrical\") care, and the use of [antibiotics](https:\/\/en.wikipedia.org\/wiki\/Antibiotics \"Antibiotics\"). Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of [scarlet fever](https:\/\/en.wikipedia.org\/wiki\/Scarlet_fever \"Scarlet fever\"), which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-29)\n\n### \"The Doctor's Plague\"\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=Postpartum_infections&action=edit&section=9 \"Edit section: \\\"The Doctor's Plague\\\"\")\\]\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/Yearly_mortality_rates_1784-1849.png\/330px-Yearly_mortality_rates_1784-1849.png)](https:\/\/en.wikipedia.org\/wiki\/File:Yearly_mortality_rates_1784-1849.png)\n\nIn his 1861 book, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") presented evidence to demonstrate that the advent of [pathological anatomy](https:\/\/en.wikipedia.org\/wiki\/Pathological_anatomy \"Pathological anatomy\") in Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of [chlorine](https:\/\/en.wikipedia.org\/wiki\/Chlorine \"Chlorine\") handwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison ([view rates](https:\/\/en.wikipedia.org\/wiki\/Historical_mortality_rates_of_puerperal_fever#Yearly_mortality_rates_for_birth_giving_women_1784-1849 \"Historical mortality rates of puerperal fever\")). His efforts were futile, however.\n\nFrom the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of [germs](https:\/\/en.wikipedia.org\/wiki\/Microorganism \"Microorganism\"), doctors did not believe hand washing was needed.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-30)\n\nHospitals for childbirth became common in the 17th century in many European cities. These \"lying-in\" hospitals were established at a time when there was no knowledge of [antisepsis](https:\/\/en.wikipedia.org\/wiki\/Antisepsis \"Antisepsis\") or [epidemiology](https:\/\/en.wikipedia.org\/wiki\/Epidemiology \"Epidemiology\"), and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nThe first recorded epidemic of puerperal fever occurred at the [Hôtel-Dieu de Paris](https:\/\/en.wikipedia.org\/wiki\/H%C3%B4tel-Dieu_de_Paris \"Hôtel-Dieu de Paris\") in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-31)\n\nIn the early 19th century, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a [maternity ward](https:\/\/en.wikipedia.org\/wiki\/Maternity_ward \"Maternity ward\"). His investigation discovered that washing hands before a delivery with a [calcium hypochlorite](https:\/\/en.wikipedia.org\/wiki\/Calcium_hypochlorite \"Calcium hypochlorite\") solution reduced childbed fever fatalities by 90%.[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-32) His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Ignaz_Semmelweis-33) The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-childbed_fever-34)\n\nSemmelweis was not the only doctor ignored after sounding a warning about the problem. In his *Treatise on the Epidemic of Puerperal Fever* (1795), ex-naval surgeon and [Aberdonian](https:\/\/en.wikipedia.org\/wiki\/Aberdeen \"Aberdeen\") obstetrician [Alexander Gordon](https:\/\/en.wikipedia.org\/wiki\/Alexander_Gordon_\\(physician\\) \"Alexander Gordon (physician)\") (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-35)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-Dr_Alexander_Gordon-36)\n\nIn 1842, [Thomas Watson](https:\/\/en.wikipedia.org\/wiki\/Sir_Thomas_Watson,_1st_Baronet \"Sir Thomas Watson, 1st Baronet\") (1792–1882), a professor of medicine at [King's College Hospital](https:\/\/en.wikipedia.org\/wiki\/King%27s_College_Hospital \"King's College Hospital\"), London, wrote: \"Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent [ablution](https:\/\/en.wikipedia.org\/wiki\/Hygiene \"Hygiene\").\" Watson recommended [handwashing](https:\/\/en.wikipedia.org\/wiki\/Handwashing \"Handwashing\") with [chlorine](https:\/\/en.wikipedia.org\/wiki\/Chlorine \"Chlorine\") solution and changes of clothing for obstetric attendants \"to prevent the practitioner becoming a vehicle of contagion and death between one patient and another.\"[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-37)[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-38)\n\nIn 1843, [Oliver Wendell Holmes Sr.](https:\/\/en.wikipedia.org\/wiki\/Oliver_Wendell_Holmes_Sr. \"Oliver Wendell Holmes Sr.\") published *The Contagiousness of Puerperal Fever* and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-39)[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-bartleby.com-40) Holmes quoted Dr. James Blundell as stating, \"... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease.\"[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-41)\n\nHolmes' conclusions were ridiculed by many contemporaries, including [Charles Delucena Meigs](https:\/\/en.wikipedia.org\/wiki\/Charles_Delucena_Meigs \"Charles Delucena Meigs\"), a well-known obstetrician, who stated, \"Doctors are gentlemen, and gentlemen's hands are clean.\"[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-42) Richard Gordon states that Holmes' exhortations \"outraged obstetricians, particularly in Philadelphia\".[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GordononMotherhood-43) In those days, \"surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon\", \"pus was as inseparable from surgery as blood\", and \"cleanliness was next to prudishness\". He quotes [Sir Frederick Treves](https:\/\/en.wikipedia.org\/wiki\/Sir_Frederick_Treves,_1st_Baronet \"Sir Frederick Treves, 1st Baronet\") on that era: \"There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head.\"[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-44)[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-GordononMotherhood44-45)\n\nIn 1844, [Ignaz Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Ignaz_Semmelweis \"Ignaz Semmelweis\") was appointed assistant lecturer in the First Obstetric Division of the [Vienna General Hospital](https:\/\/en.wikipedia.org\/wiki\/Vienna_General_Hospital \"Vienna General Hospital\") (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, [Jakob Kolletschka](https:\/\/en.wikipedia.org\/wiki\/Jakob_Kolletschka \"Jakob Kolletschka\"), died of sepsis after a student accidentally cut his hand while performing an autopsy.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nSemmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-raju-46) While his results were extraordinary, he was treated with skepticism and ridicule (see [Response to Semmelweis](https:\/\/en.wikipedia.org\/wiki\/Contemporary_reaction_to_Ignaz_Semmelweis \"Contemporary reaction to Ignaz Semmelweis\")).\n\nHe did the same work in St. Rochus hospital in [Pest, Hungary](https:\/\/en.wikipedia.org\/wiki\/Pest,_Hungary \"Pest, Hungary\"), and published his findings in 1860, but his discovery was again ignored.[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-colyer-47)\n\nIn 1935, [Leonard Colebrook](https:\/\/en.wikipedia.org\/wiki\/Leonard_Colebrook \"Leonard Colebrook\") showed [Prontosil](https:\/\/en.wikipedia.org\/wiki\/Prontosil \"Prontosil\") was effective against [haemolytic](https:\/\/en.wikipedia.org\/wiki\/Haemolysis \"Haemolysis\") [streptococcus](https:\/\/en.wikipedia.org\/wiki\/Streptococcus \"Streptococcus\") and hence a cure for puerperal fever.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-48)[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-49)\n\nElite status was no protection against postpartum infections, as the deaths of several English queens attest. [Elizabeth of York](https:\/\/en.wikipedia.org\/wiki\/Elizabeth_of_York \"Elizabeth of York\"), queen consort of [Henry VII](https:\/\/en.wikipedia.org\/wiki\/Henry_VII_of_England \"Henry VII of England\"), died of puerperal fever one week after giving birth to a daughter, who also died. Her son [Henry VIII](https:\/\/en.wikipedia.org\/wiki\/Henry_VIII \"Henry VIII\") had two wives who died this way, [Jane Seymour](https:\/\/en.wikipedia.org\/wiki\/Jane_Seymour \"Jane Seymour\")\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\] and [Catherine Parr](https:\/\/en.wikipedia.org\/wiki\/Catherine_Parr \"Catherine Parr\").[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-50)\n\nSuzanne Barnard, mother of philosopher [Jean-Jacques Rousseau](https:\/\/en.wikipedia.org\/wiki\/Jean-Jacques_Rousseau \"Jean-Jacques Rousseau\"), contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that \"I came into the world with so few signs of life that little hope was entertained of preserving me\". He was nursed back to health by an aunt.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-51) French natural philosopher [Émilie du Châtelet](https:\/\/en.wikipedia.org\/wiki\/%C3%89milie_du_Ch%C3%A2telet \"Émilie du Châtelet\") died in 1749. [Mary Wollstonecraft](https:\/\/en.wikipedia.org\/wiki\/Mary_Wollstonecraft \"Mary Wollstonecraft\"), author of *[Vindication of the Rights of Woman](https:\/\/en.wikipedia.org\/wiki\/Vindication_of_the_Rights_of_Woman \"Vindication of the Rights of Woman\")*, died ten days after giving birth to [her second daughter](https:\/\/en.wikipedia.org\/wiki\/Mary_Shelley \"Mary Shelley\"), who grew up to write *[Frankenstein](https:\/\/en.wikipedia.org\/wiki\/Frankenstein \"Frankenstein\")*. Other notables include African-American poet [Phillis Wheatley](https:\/\/en.wikipedia.org\/wiki\/Phillis_Wheatley \"Phillis Wheatley\") (1784), British housekeeping authority [Isabella Beeton](https:\/\/en.wikipedia.org\/wiki\/Isabella_Beeton \"Isabella Beeton\") (1865),[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-52)[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_note-53) and American author [Jean Webster](https:\/\/en.wikipedia.org\/wiki\/Jean_Webster \"Jean Webster\") in 1916 died of puerperal fever.\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\]\n\nIn [Charles Dickens](https:\/\/en.wikipedia.org\/wiki\/Charles_Dickens \"Charles Dickens\")' novel *[A Christmas Carol](https:\/\/en.wikipedia.org\/wiki\/A_Christmas_Carol \"A Christmas Carol\")*, it is implied that both [Scrooge's](https:\/\/en.wikipedia.org\/wiki\/Ebenezer_Scrooge \"Ebenezer Scrooge\") mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father\\[*[citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed \"Wikipedia:Citation needed\")*\\].\n\n- [Postpartum confinement](https:\/\/en.wikipedia.org\/wiki\/Postpartum_confinement \"Postpartum confinement\"), a traditional practice after childbirth\n\n1. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-6) [***h***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-7) [***i***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-8) [***j***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-9) [***k***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-10) [***l***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-11) [***m***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-12) [***n***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-13) [***o***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-14) [***p***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-15) [***q***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-16) [***r***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-17) [***s***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-18) [***t***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-19) [***u***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-20) [***v***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-W2014_1-21)\n   \"37\". *Williams Obstetrics* (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-07-179893-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-07-179893-8 \"Special:BookSources\/978-0-07-179893-8\")\n   \n   .\n2. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-2) [***d***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-3) [***e***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-4) [***f***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-5) [***g***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-WHOBook2015_2-6)\n   [*WHO recommendations for prevention and treatment of maternal peripartum infections*](http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf) (PDF). World Health Organization. 2015. p. 1. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-92-4-154936-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-92-4-154936-3 \"Special:BookSources\/978-92-4-154936-3\")\n   \n   . [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26598777](https:\/\/pubmed.ncbi.nlm.nih.gov\/26598777). [Archived](https:\/\/web.archive.org\/web\/20160207091250\/http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf) (PDF) from the original on 2016-02-07.\n3. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015Pre_3-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015Pre_3-1)\n   GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). [\"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055577). *Lancet*. **388** (10053): 1545–1602\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0140-6736(16)31678-6](https:\/\/doi.org\/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5055577](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5055577). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27733282](https:\/\/pubmed.ncbi.nlm.nih.gov\/27733282).\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015De_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GBD2015De_4-1)\n   GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). [\"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5388903). *Lancet*. **388** (10053): 1459–1544\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/s0140-6736(16)31012-1](https:\/\/doi.org\/10.1016%2Fs0140-6736%2816%2931012-1). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5388903](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5388903). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [27733281](https:\/\/pubmed.ncbi.nlm.nih.gov\/27733281).\n5. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hir2014_5-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hir2014_5-1)\n   Hiralal Konar (2014). [*DC Dutta's Textbook of Obstetrics*](https:\/\/books.google.com\/books?id=LU2VAwAAQBAJ&pg=PA432). JP Medical Ltd. p. 432. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-93-5152-067-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-93-5152-067-2 \"Special:BookSources\/978-93-5152-067-2\")\n   \n   . [Archived](https:\/\/web.archive.org\/web\/20151208041911\/https:\/\/books.google.ca\/books?id=LU2VAwAAQBAJ&pg=PA432) from the original on 2015-12-08.\n6. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Hac2015_6-0)**\n   \"Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology\". *Hacker & Moore's essentials of obstetrics and gynecology* (6 ed.). Elsevier Canada. 2015. pp. 276–290\\. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-1-4557-7558-3](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4557-7558-3 \"Special:BookSources\/978-1-4557-7558-3\")\n   \n   .\n7. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GDB2013_7-0)**\n   GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). [\"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604). *Lancet*. **385** (9963): 117–171\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0140-6736(14)61682-2](https:\/\/doi.org\/10.1016%2FS0140-6736%2814%2961682-2). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [4340604](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4340604). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [25530442](https:\/\/pubmed.ncbi.nlm.nih.gov\/25530442).\n8. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-8)**\n   Walvekar V (2005). [*Manual of perinatal infections*](https:\/\/books.google.com\/books?id=DIOmY2ROeVAC&pg=PA152). New Delhi: Jaypee Bros. p. 153. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-81-8061-472-9](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-81-8061-472-9 \"Special:BookSources\/978-81-8061-472-9\")\n   \n   . [Archived](https:\/\/web.archive.org\/web\/20160304220030\/https:\/\/books.google.ca\/books?id=DIOmY2ROeVAC&pg=PA152) from the original on 2016-03-04.\n9. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-9)**\n   Magner LN (1992). [*A history of medicine*](https:\/\/archive.org\/details\/historyofmedicin0000magn). New York: Dekker. pp. [257](https:\/\/archive.org\/details\/historyofmedicin0000magn\/page\/257)–258. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-8247-8673-1](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-8247-8673-1 \"Special:BookSources\/978-0-8247-8673-1\")\n   \n   .\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-10)**\n    Anderson BL (April 2014). \"Puerperal group A streptococcal infection: beyond Semmelweis\". *Obstetrics and Gynecology*. **123** (4): 874–882\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/aog.0000000000000175](https:\/\/doi.org\/10.1097%2Faog.0000000000000175). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24785617](https:\/\/pubmed.ncbi.nlm.nih.gov\/24785617). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [24685091](https:\/\/api.semanticscholar.org\/CorpusID:24685091).\n11. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-11)**\n    Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). [\"Medicine in stamps-Ignaz Semmelweis and Puerperal Fever\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3881728). *Journal of the Turkish German Gynecological Association*. **14** (1): 35–9\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.5152\/jtgga.2013.08](https:\/\/doi.org\/10.5152%2Fjtgga.2013.08). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [3881728](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3881728). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24592068](https:\/\/pubmed.ncbi.nlm.nih.gov\/24592068).\n12. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-12)**\n    Andy W Wong (2024-03-27). [\"Postpartum Infections\"](https:\/\/emedicine.medscape.com\/article\/796892-overview). *Medscape*. Retrieved 2025-03-14.\n13. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-13)**\n    Befekadu Tesfaye Oyato (2024-06-20). [\"Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC11328626). *BMJ Open*. **14** (6) e083230. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1136\/bmjopen-2023-083230](https:\/\/doi.org\/10.1136%2Fbmjopen-2023-083230). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [11328626](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC11328626). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [38908838](https:\/\/pubmed.ncbi.nlm.nih.gov\/38908838).\n14. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-gfmer.ch_14-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-gfmer.ch_14-1) [The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review](http:\/\/www.gfmer.ch\/Medical_education_En\/PGC_RH_2004\/Pdf\/Chisembele_Puerperal_sepsis.pdf) [Archived](https:\/\/web.archive.org\/web\/20081217023721\/http:\/\/www.gfmer.ch\/Medical_education_En\/PGC_RH_2004\/Pdf\/Chisembele_Puerperal_sepsis.pdf) 2008-12-17 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n15. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-15)** Carter (2005):98\n16. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-16)**\n    Berenson AB (April 1990). [\"Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents\"](http:\/\/journals.lww.com\/greenjournal\/abstract\/1990\/04000\/bacteriologic_findings_of_post_cesarean.12.aspx). *Obstetrics and Gynecology*. **75** (4): 627–629\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [2314783](https:\/\/pubmed.ncbi.nlm.nih.gov\/2314783). [Archived](https:\/\/web.archive.org\/web\/20131103084443\/http:\/\/journals.lww.com\/greenjournal\/abstract\/1990\/04000\/bacteriologic_findings_of_post_cesarean.12.aspx) from the original on 2013-11-03.\n17. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-17)**\n    [\"Atelectasis\"](https:\/\/www.lecturio.com\/concepts\/atelectasis\/). *The Lecturio Medical Concept Library*. Retrieved 7 July 2021.\n18. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-18)**\n    [\"Urinary Tract Infection\"](https:\/\/www.cdc.gov\/getsmart\/community\/for-patients\/common-illnesses\/uti.html). *[Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC)*. 17 April 2015. [Archived](https:\/\/web.archive.org\/web\/20160222034940\/http:\/\/www.cdc.gov\/getsmart\/community\/for-patients\/common-illnesses\/uti.html) from the original on 22 February 2016. Retrieved 7 July 2021.\n19. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-19)**\n    Crum CP, Lee KR, Nucci MR (2011). [*Diagnostic Gynecologic and Obstetric Pathology E-Book*](https:\/\/books.google.com\/books?id=d91mO9WYtPYC&pg=PA430). Elsevier Health Sciences. p. 430. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-1-4557-0895-6](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4557-0895-6 \"Special:BookSources\/978-1-4557-0895-6\")\n    \n    .\n20. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-20)** [Definition of \"infection\" from several medical dictionaries](http:\/\/medical-dictionary.thefreedictionary.com\/infection) – Retrieved on 2021-07-07\n21. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-21)**\n    Callaghan T. *Blueprint Obstetrics and Gynecology*.\n22. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-22)**\n    Berens PD (December 2015). [\"Breast Pain: Engorgement, Nipple Pain, and Mastitis\"](https:\/\/semanticscholar.org\/paper\/a3f96251efd59a92f82ed618dda1fea955027fbe). *Clinical Obstetrics and Gynecology*. **58** (4): 902–14\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1097\/GRF.0000000000000153](https:\/\/doi.org\/10.1097%2FGRF.0000000000000153). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26512442](https:\/\/pubmed.ncbi.nlm.nih.gov\/26512442). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [13006527](https:\/\/api.semanticscholar.org\/CorpusID:13006527).\n23. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-23)**\n    [\"WHO recommendations for prevention and treatment of maternal peripartum infections\"](http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf?ua=1) (PDF). [Archived](https:\/\/web.archive.org\/web\/20160306061338\/http:\/\/apps.who.int\/iris\/bitstream\/10665\/186171\/1\/9789241549363_eng.pdf?ua=1) (PDF) from the original on 2016-03-06.\n24. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-24)**\n    Carter KC, Carter BR (2005). *Childbed fever. A scientific biography of Ignaz Semmelweis*. Transaction Publishers. p. 100. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-1-4128-0467-7](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-4128-0467-7 \"Special:BookSources\/978-1-4128-0467-7\")\n    \n    .\n25. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-25)**\n    [Lewis G](https:\/\/en.wikipedia.org\/wiki\/Gwyneth_Lewis_\\(scientist\\) \"Gwyneth Lewis (scientist)\"), ed. (2007). [*Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom*](http:\/\/www.cemach.org.uk\/getattachment\/8f5c1ed8-fdf3-489b-a182-e53955bec07b\/Saving-Mothers--Lives-2003%E2%80%932005_full.aspx). CEMACH. p. 97. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-9533536-8-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-9533536-8-2 \"Special:BookSources\/978-0-9533536-8-2\")\n    \n    .\n    \n    \\[*[permanent dead link](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot \"Wikipedia:Link rot\")*\\]\n26. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-26)** [CEMACH: Saving Mothers' Lives 2003–2005](http:\/\/www.cemach.org.uk\/Publications\/CEMACH-Publications\/Maternal-and-Perinatal-Health.aspx) [Archived](https:\/\/web.archive.org\/web\/20080521093900\/http:\/\/www.cemach.org.uk\/Publications\/CEMACH-Publications\/Maternal-and-Perinatal-Health.aspx) 2008-05-21 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n27. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-27)**\n    [Loudon I](https:\/\/en.wikipedia.org\/wiki\/Irvine_Loudon \"Irvine Loudon\") (9 March 2000). [*The Tragedy of Childbed Fever*](https:\/\/web.archive.org\/web\/20120211075531\/http:\/\/fds.oup.com\/www.oup.co.uk\/pdf\/0-19-820499-X.pdf) (PDF). Oxford University Press, USA. p. 6. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-19-820499-2](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-19-820499-2 \"Special:BookSources\/978-0-19-820499-2\")\n    \n    . Archived from [the original](http:\/\/fds.oup.com\/www.oup.co.uk\/pdf\/0-19-820499-X.pdf) (PDF) on 11 February 2012.\n28. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-28)** The debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8.\n29. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-29)**\n    Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). [\"Scarlet fever: a guide for general practitioners\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5649319). *London Journal of Primary Care*. **9** (5): 77–79\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1080\/17571472.2017.1365677](https:\/\/doi.org\/10.1080%2F17571472.2017.1365677). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1757-1472](https:\/\/search.worldcat.org\/issn\/1757-1472). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [5649319](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5649319). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [29081840](https:\/\/pubmed.ncbi.nlm.nih.gov\/29081840).\n30. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-30)**\n    Rebecca Davis (2015-01-12). [\"The doctor who championed hand-washing and saved women's lives\"](https:\/\/www.npr.org\/sections\/health-shots\/2015\/01\/12\/375663920\/the-doctor-who-championed-hand-washing-and-saved-women-s-lives). *[National Public Radio](https:\/\/en.wikipedia.org\/wiki\/National_Public_Radio \"National Public Radio\")*. Retrieved 2025-03-14.\n31. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-31)** Loudon I. \"Deaths in childbed from the eighteenth century to 1935\". *Med History* 1986; 30: 1–41\n32. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-32)**\n    Caplan CE (1995). [\"The Childbed Fever Mystery and the Meaning of Medical Journalism\"](https:\/\/web.archive.org\/web\/20120707205101\/http:\/\/www.med.mcgill.ca\/mjm\/issues\/v01n01\/fever.html). *McGill Journal of Medicine*. **1** (1). Archived from [the original](http:\/\/www.med.mcgill.ca\/mjm\/issues\/v01n01\/fever.html) on 2012-07-07.\n33. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Ignaz_Semmelweis_33-0)**\n    Wyklicky H, Skopec M (1983). \"Ignaz Philipp Semmelweis, the prophet of bacteriology\". *Infect Control*. **4** (5): 367–370\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1017\/S0195941700059762](https:\/\/doi.org\/10.1017%2FS0195941700059762). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [6354955](https:\/\/pubmed.ncbi.nlm.nih.gov\/6354955). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [25830725](https:\/\/api.semanticscholar.org\/CorpusID:25830725).\n34. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-childbed_fever_34-0)**\n    De Costa CM (Nov 2002). [\"\"The contagiousness of childbed fever\": a short history of puerperal sepsis and its treatment\"](http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html). *The Medical Journal of Australia*. **177** (11–12\\): 668–671\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.5694\/j.1326-5377.2002.tb05004.x](https:\/\/doi.org\/10.5694%2Fj.1326-5377.2002.tb05004.x). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12463995](https:\/\/pubmed.ncbi.nlm.nih.gov\/12463995). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [12164328](https:\/\/api.semanticscholar.org\/CorpusID:12164328). [Archived](https:\/\/web.archive.org\/web\/20061203030203\/http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html) from the original on 2006-12-03.\n35. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-35)**\n    Gordon A (1795). [*A Treatise on the Epidemic Puerperal Fever of Aberdeen*](https:\/\/archive.org\/details\/treatiseonepidem00gord). London, England: G.G. and J. Robinson. pp. [63](https:\/\/archive.org\/details\/treatiseonepidem00gord\/page\/63)–64.\n    \n    On p. 63, Gordon recognized that puerperal fever was infectious: \"But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted.\" From p. 64: \"It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women.\"\n36. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-Dr_Alexander_Gordon_36-0)**\n    [\"Treatise on the Epidemic of Puerperal Fever\"](https:\/\/web.archive.org\/web\/20080720005441\/http:\/\/www.general-anaesthesia.com\/images\/ignaz-semmelweis.html). www.general-anaesthesia.com. Archived from [the original](https:\/\/www.general-anaesthesia.com\/images\/ignaz-semmelweis.html) on July 20, 2008. Retrieved September 15, 2011.\n37. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-37)**\n    Watson (February 18, 1842). [\"Lectures on the principles and practice of physic: Diseases of the abdomen\"](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015018029671&view=1up&seq=811). *The London Medical Gazette*. **29**: 801–808\\.\n    \n    [From p. 806](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015018029671&view=1up&seq=816): \"Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another.\"\n38. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-38)** [*The Medical Journal of Australia.*\"The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment\"](http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html#i1067496) [Archived](https:\/\/web.archive.org\/web\/20061203030203\/http:\/\/www.mja.com.au\/public\/issues\/177_11_021202\/dec10354_fm.html) 2006-12-03 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n39. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-39)**\n    Holmes OW (1842–1843). [\"On the contagiousness of puerperal fever\"](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015059415961&view=1up&seq=513). *The New England Quarterly Journal of Medicine*. **1**: 503–530\\.\n40. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-bartleby.com_40-0)** [Oliver Wendell Holmes: *The Contagiousness of Puerperal Fever*](http:\/\/www.bartleby.com\/38\/5\/1.html) [Archived](https:\/\/web.archive.org\/web\/20070203165344\/http:\/\/www.bartleby.com\/38\/5\/1.html) 2007-02-03 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\")\n41. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-41)** (Holmes, 1842–1843), [p. 510.](https:\/\/babel.hathitrust.org\/cgi\/pt?id=mdp.39015059415961&view=1up&seq=520)\n42. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-42)**\n    Meigs CD (1854). [*On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class*](https:\/\/archive.org\/details\/onnaturesignstre1854meig). Philadelphia, Pennsylvania: Blanchard and Lea. p. [104](https:\/\/archive.org\/details\/onnaturesignstre1854meig\/page\/104).\n    \n    From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: \"He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean.\"\n43. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GordononMotherhood_43-0)**\n    [Gordon R](https:\/\/en.wikipedia.org\/wiki\/Richard_Gordon_\\(English_author\\) \"Richard Gordon (English author)\") (1983). \"Disastrous Motherhood: Tales from the Vienna Wards\". *Great Medical Disasters*. London: Hutchinson & Co. pp. 43–46 \\[43\\].\n44. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-44)**\n    Treves F (1923). \"Ch. 2: The Old Receiving Room\". [*The Elephant Man and Other Reminiscences*](https:\/\/archive.org\/details\/elephantmanother00trevuoft). London, England: Cassell and Company, Ltd. pp. [56](https:\/\/archive.org\/details\/elephantmanother00trevuoft\/page\/56)–57.\n45. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-GordononMotherhood44_45-0)** Gordon, Richard (1983) p. 44\n46. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-raju_46-0)**\n    Raju TN (1999). \"Ignác Semmelweis and the etiology of fetal and neonatal sepsis\". *Journal of Perinatology*. **19** (4): 307–310\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1038\/sj.jp.7200155](https:\/\/doi.org\/10.1038%2Fsj.jp.7200155). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [10685244](https:\/\/pubmed.ncbi.nlm.nih.gov\/10685244). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [29047987](https:\/\/api.semanticscholar.org\/CorpusID:29047987).\n47. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-colyer_47-0)** Christa Colyer.[\"Childbed fever: a nineteenth-century mystery,\"](http:\/\/www.sciencecases.org\/childbed_fever\/childbed_fever.asp) [Archived](https:\/\/web.archive.org\/web\/20090416054052\/http:\/\/www.sciencecases.org\/childbed_fever\/childbed_fever.asp) 2009-04-16 at the [Wayback Machine](https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine \"Wayback Machine\") National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003).\n48. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-48)** Colebrook, L; Kenny, M (June 6, 1936). \"Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil\".*Lancet* **227**(1): 1279–1286.\n49. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-49)**\n    Sue Bale, Vanessa Jones (2006). [*Wound care nursing*](https:\/\/books.google.com\/books?id=zbIuXxpoRXMC&q=fireguards+act+1952&pg=PA54). Elsevier Health Sciences. p. 54. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-7234-3344-6](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7234-3344-6 \"Special:BookSources\/978-0-7234-3344-6\")\n    \n    . Retrieved 2009-08-05.\n50. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-50)**\n    Sophie Campbell (2012-08-14). [\"Sudeley Castle: the curious life and death of Katherine Parr\"](https:\/\/www.telegraph.co.uk\/travel\/destinations\/europe\/united-kingdom\/england\/cotswolds\/articles\/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr\/). *The Telegraph*. Retrieved 2025-03-14.\n51. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-51)** Quoted from [Will Durant](https:\/\/en.wikipedia.org\/wiki\/Will_Durant \"Will Durant\")'s \"The Age of Rousseau\".\\[*[full citation needed](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources#What_information_to_include \"Wikipedia:Citing sources\")*\\]\n52. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-52)**\n    Beetham M (2004). [\"Beeton, Samuel Orchart (1831–1877)\"](http:\/\/www.oxforddnb.com\/view\/article\/45481). *[Oxford Dictionary of National Biography](https:\/\/en.wikipedia.org\/wiki\/Dictionary_of_National_Biography#Oxford_Dictionary_of_National_Biography \"Dictionary of National Biography\")* (online ed.). Oxford University Press. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1093\/ref:odnb\/45481](https:\/\/doi.org\/10.1093%2Fref%3Aodnb%2F45481). Retrieved 23 November 2015.\n    \n    `{{cite encyclopedia}}`: CS1 maint: ref duplicates default ([link](https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_ref_duplicates_default \"Category:CS1 maint: ref duplicates default\")) (Subscription, [Wikipedia Library](https:\/\/wikipedialibrary.wmflabs.org\/partners\/88\/) access or [UK public library membership](https:\/\/www.oxforddnb.com\/help\/subscribe#public) required.)\n53. **[^](https:\/\/en.wikipedia.org\/wiki\/Postpartum_infections#cite_ref-53)**\n    [Hughes K](https:\/\/en.wikipedia.org\/wiki\/Kathryn_Hughes \"Kathryn Hughes\") (2006). [*The Short Life and Long Times of Mrs Beeton*](https:\/\/books.google.com\/books?id=p5NvuLMB3tYC&pg=PP1). London: HarperCollins Publishers. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n    \n    [978-0-7524-6122-9](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-7524-6122-9 \"Special:BookSources\/978-0-7524-6122-9\")\n    \n    .\n\n- Chaim W, Burstein E (August 2003). \"Postpartum infection treatments: a review\". *Expert Opinion on Pharmacotherapy* (review). **4** (8): 1297–313\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1517\/14656566.4.8.1297](https:\/\/doi.org\/10.1517%2F14656566.4.8.1297). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12877638](https:\/\/pubmed.ncbi.nlm.nih.gov\/12877638). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [26781321](https:\/\/api.semanticscholar.org\/CorpusID:26781321).\n- French L (August 2003). \"Prevention and treatment of postpartum endometritis\". *Current Women's Health Reports* (review). **3** (4): 274–9\\. [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [12844449](https:\/\/pubmed.ncbi.nlm.nih.gov\/12844449).\n- Calhoun BC, Brost B (June 1995). \"Emergency management of sudden puerperal fever\". *Obstetrics and Gynecology Clinics of North America* (review). **22** (2): 357–67\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/S0889-8545(21)00185-6](https:\/\/doi.org\/10.1016%2FS0889-8545%2821%2900185-6). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [7651676](https:\/\/pubmed.ncbi.nlm.nih.gov\/7651676).","meta_canonical":null}

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Boilerpipe Text	Postpartum infections Other names Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections Streptococcus pyogenes (red-stained spheres) is responsible for many cases of severe puerperal fever. Specialty Obstetrics Symptoms Fever, lower abdominal pain, bad-smelling vaginal discharge [ 1 ] Causes Typically multiple types of bacteria [ 1 ] Risk factors Caesarean section , premature rupture of membranes , prolonged labour , malnutrition , diabetes [ 1 ] [ 2 ] Treatment Antibiotics [ 1 ] Frequency 11.8 million [ 3 ] Deaths 17,900 [ 4 ] Postpartum infections , also known as childbed fever and puerperal fever , are any bacterial infections of the female reproductive tract following childbirth or miscarriage . [ 1 ] Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous vaginal discharge . [ 1 ] It usually occurs after the first 24 hours and within the first ten days following delivery. [ 5 ] The most common infection is that of the uterus and surrounding tissues known as puerperal sepsis , postpartum metritis , or postpartum endometritis . [ 1 ] [ 6 ] Risk factors include caesarean section (C-section), the presence of certain bacteria such as group B streptococcus in the vagina, premature rupture of membranes , multiple vaginal exams , manual removal of the placenta , and prolonged labour among others. [ 1 ] [ 2 ] Most infections involve a number of types of bacteria. [ 1 ] Diagnosis is rarely helped by culturing of the vagina or blood. [ 1 ] In those who do not improve, medical imaging may be required. [ 1 ] Other causes of fever following delivery include breast engorgement , urinary tract infections , infections of an abdominal incision or an episiotomy , and atelectasis . [ 1 ] [ 2 ] Due to the risks following caesarean section, it is recommended that all women receive a preventive dose of antibiotics such as ampicillin around the time of surgery. [ 1 ] Treatment of established infections is with antibiotics, with most people improving in two to three days. [ 1 ] In those with mild disease, oral antibiotics may be used; otherwise, intravenous antibiotics are recommended. [ 1 ] Common antibiotics include a combination of ampicillin and gentamicin following vaginal delivery or clindamycin and gentamicin in those who have had a C-section. [ 1 ] In those who are not improving with appropriate treatment, other complications such as an abscess should be considered. [ 1 ] In 2015, about 11.8 million maternal infections occurred. [ 3 ] In the developed world about 1% to 2% develop uterine infections following vaginal delivery . [ 1 ] This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics. [ 1 ] In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990. [ 4 ] [ 7 ] They are the cause of about 10% of deaths around the time of pregnancy. [ 2 ] The first known descriptions of the condition date back to at least the 5th century BCE in the writings of Hippocrates . [ 8 ] These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced. [ 9 ] In 1847, Hungarian physician Ignaz Semmelweiss decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of handwashing with calcium hypochlorite . [ 10 ] [ 11 ] Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge. [ 1 ] It usually occurs after the first 24 hours and within the first ten days following delivery. [ 5 ] After childbirth, the female genital tract has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the uterus , or it may spread beyond to cause sepsis or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the placenta (afterbirth), but pathogenic organisms may also affect lacerations of any part of the genital tract. By whatever portal, they can invade the bloodstream and lymph system to cause sepsis , cellulitis (inflammation of connective tissue), and pelvic or generalized peritonitis (inflammation of the abdominal lining). The severity of the illness depends on the virulence of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are Streptococcus pyogenes ; staphylococci (inhabitants of the skin and of pimples , carbuncles , and many other pustular eruptions); the anaerobic streptococci , which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; Escherichia coli [ 12 ] and Clostridium perfringens (inhabitants of the lower bowel); and Clostridium tetani . [ 13 ] Causes (listed in order of decreasing frequency) include: endometritis , urinary tract infection , pneumonia / atelectasis , wound infection , and septic pelvic thrombophlebitis . Sepsis risk factors for each condition are listed in order of the postpartum day (PPD) on which the condition generally occurs. [ citation needed ] PPD 0: atelectasis risk factors include general anesthesia , cigarette smoking , and obstructive lung disease . PPD 1–2: urinary tract infection risk factors include multiple catheterization during labor, multiple vaginal examinations during labor, and untreated bacteriuria . PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor. PPD 4–5: wound infection risk factors include emergency cesarean section , prolonged membrane rupture , prolonged labor, and multiple vaginal examinations during labor. PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth. PPD 7–21: mastitis risk factors include nipple trauma from breastfeeding . Puerperal fever is diagnosed with: A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10) Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW) [ 14 ] Puerperal fever (from the Latin puer , male child (boy) ), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies: [ 15 ] the specific target of infection: endometritis (inflammation of the inner lining of the uterus), metrophlebitis (inflammation of the veins of the uterus), and peritonitis (inflammation of the membrane lining of the abdomen). the severity of the infection: less serious infection (contained multiplication of microbes) or possibly life-threatening sepsis (uncontrolled and uncontained multiplication of microbes throughout the bloodstream). Endometritis is a polymicrobial infection. It frequently includes organisms such as Ureaplasma , Streptococcus , Mycoplasma , and Bacteroides , and may also include organisms such as Gardnerella , Chlamydia , Lactobacillus , Escherichia , and Staphylococcus . [ 16 ] Differential diagnosis [ edit ] Several other conditions can cause fevers following delivery, including: urinary tract infections , breast engorgement , atelectasis , and surgical incisions, among others. [ 1 ] Antibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health. [ 2 ] It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective. [ 2 ] Atelectasis : mild to moderate fever, no changes or mild rales on chest auscultation . [ 17 ] Management: pulmonary exercises, ambulation (deep breathing and walking). Urinary tract infection : high fever, malaise, costovertebral tenderness, positive urine culture. [ 18 ] Management: antibiotics as per culture sensitivity (cephalosporin). Endometritis : moderate fever, exquisite uterine tenderness, minimal abdominal findings. [ 19 ] Management: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary. Wound infection : persistent spiking fever despite antibiotics, wound erythema or fluctuance, wound drainage. [ 20 ] Management: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure. Septic pelvic thrombophlebitis : persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams. [ 21 ] Management: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values. Mastitis : unilateral, localized erythema, edema , tenderness. [ 22 ] Management: antibiotics for cellulitis, open and drain the abscess if present. The number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc. [ 14 ] Globally, bacterial infections are the cause of 10% of maternal deaths —this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries. [ 2 ] [ 23 ] In the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is caesarean section . [ 24 ] The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States. [ 1 ] In the United Kingdom from 1985 to 2005, the number of direct deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85. [ 25 ] In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death. [ 26 ] Puerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to childbirth , and was second only to tuberculosis in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone. [ 27 ] Although it had been recognized from as early as the time of the Hippocratic corpus that women in childbed were prone to fevers, the distinct name "puerperal fever" appears in historical records only from the early 18th century. [ 28 ] The death rate for women giving birth decreased in the 20th century in developed countries . The decline may be partly attributed to improved environmental conditions, better obstetrical care, and the use of antibiotics . Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of scarlet fever , which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969. [ 29 ] "The Doctor's Plague" [ edit ] In his 1861 book, Ignaz Semmelweis presented evidence to demonstrate that the advent of pathological anatomy in Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of chlorine handwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison ( view rates ). His efforts were futile, however. From the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of germs , doctors did not believe hand washing was needed. [ 30 ] Hospitals for childbirth became common in the 17th century in many European cities. These "lying-in" hospitals were established at a time when there was no knowledge of antisepsis or epidemiology , and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients. [ citation needed ] The first recorded epidemic of puerperal fever occurred at the Hôtel-Dieu de Paris in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards. [ 31 ] In the early 19th century, Ignaz Semmelweis noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a maternity ward . His investigation discovered that washing hands before a delivery with a calcium hypochlorite solution reduced childbed fever fatalities by 90%. [ 32 ] His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves. [ 33 ] The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum. [ 34 ] Semmelweis was not the only doctor ignored after sounding a warning about the problem. In his Treatise on the Epidemic of Puerperal Fever (1795), ex-naval surgeon and Aberdonian obstetrician Alexander Gordon (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women." [ 35 ] [ 36 ] In 1842, Thomas Watson (1792–1882), a professor of medicine at King's College Hospital , London, wrote: "Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent ablution ." Watson recommended handwashing with chlorine solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another." [ 37 ] [ 38 ] In 1843, Oliver Wendell Holmes Sr. published The Contagiousness of Puerperal Fever and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease. [ 39 ] [ 40 ] Holmes quoted Dr. James Blundell as stating, "... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease." [ 41 ] Holmes' conclusions were ridiculed by many contemporaries, including Charles Delucena Meigs , a well-known obstetrician, who stated, "Doctors are gentlemen, and gentlemen's hands are clean." [ 42 ] Richard Gordon states that Holmes' exhortations "outraged obstetricians, particularly in Philadelphia". [ 43 ] In those days, "surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "cleanliness was next to prudishness". He quotes Sir Frederick Treves on that era: "There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head." [ 44 ] [ 45 ] In 1844, Ignaz Semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna General Hospital (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, Jakob Kolletschka , died of sepsis after a student accidentally cut his hand while performing an autopsy. [ citation needed ] Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year. [ 46 ] While his results were extraordinary, he was treated with skepticism and ridicule (see Response to Semmelweis ). He did the same work in St. Rochus hospital in Pest, Hungary , and published his findings in 1860, but his discovery was again ignored. [ 47 ] In 1935, Leonard Colebrook showed Prontosil was effective against haemolytic streptococcus and hence a cure for puerperal fever. [ 48 ] [ 49 ] Elite status was no protection against postpartum infections, as the deaths of several English queens attest. Elizabeth of York , queen consort of Henry VII , died of puerperal fever one week after giving birth to a daughter, who also died. Her son Henry VIII had two wives who died this way, Jane Seymour [ citation needed ] and Catherine Parr . [ 50 ] Suzanne Barnard, mother of philosopher Jean-Jacques Rousseau , contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that "I came into the world with so few signs of life that little hope was entertained of preserving me". He was nursed back to health by an aunt. [ 51 ] French natural philosopher Émilie du Châtelet died in 1749. Mary Wollstonecraft , author of Vindication of the Rights of Woman , died ten days after giving birth to her second daughter , who grew up to write Frankenstein . Other notables include African-American poet Phillis Wheatley (1784), British housekeeping authority Isabella Beeton (1865), [ 52 ] [ 53 ] and American author Jean Webster in 1916 died of puerperal fever. [ citation needed ] In Charles Dickens ' novel A Christmas Carol , it is implied that both Scrooge's mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father [ citation needed ] . Postpartum confinement , a traditional practice after childbirth ^ a b c d e f g h i j k l m n o p q r s t u v "37". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. ISBN 978-0-07-179893-8 . ^ a b c d e f g WHO recommendations for prevention and treatment of maternal peripartum infections (PDF) . World Health Organization. 2015. p. 1. ISBN 978-92-4-154936-3 . PMID 26598777 . Archived (PDF) from the original on 2016-02-07. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" . Lancet . 388 (10053): 1545– 1602. doi : 10.1016/S0140-6736(16)31678-6 . PMC 5055577 . PMID 27733282 . ^ a b GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015" . Lancet . 388 (10053): 1459– 1544. doi : 10.1016/s0140-6736(16)31012-1 . PMC 5388903 . PMID 27733281 . ^ a b Hiralal Konar (2014). DC Dutta's Textbook of Obstetrics . JP Medical Ltd. p. 432. ISBN 978-93-5152-067-2 . Archived from the original on 2015-12-08. ^ "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276– 290. ISBN 978-1-4557-7558-3 . ^ GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" . Lancet . 385 (9963): 117– 171. doi : 10.1016/S0140-6736(14)61682-2 . PMC 4340604 . PMID 25530442 . ^ Walvekar V (2005). Manual of perinatal infections . New Delhi: Jaypee Bros. p. 153. ISBN 978-81-8061-472-9 . Archived from the original on 2016-03-04. ^ Magner LN (1992). A history of medicine . New York: Dekker. pp. 257 –258. ISBN 978-0-8247-8673-1 . ^ Anderson BL (April 2014). "Puerperal group A streptococcal infection: beyond Semmelweis". Obstetrics and Gynecology . 123 (4): 874– 882. doi : 10.1097/aog.0000000000000175 . PMID 24785617 . S2CID 24685091 . ^ Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). "Medicine in stamps-Ignaz Semmelweis and Puerperal Fever" . Journal of the Turkish German Gynecological Association . 14 (1): 35– 9. doi : 10.5152/jtgga.2013.08 . PMC 3881728 . PMID 24592068 . ^ Andy W Wong (2024-03-27). "Postpartum Infections" . Medscape . Retrieved 2025-03-14 . ^ Befekadu Tesfaye Oyato (2024-06-20). "Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia" . BMJ Open . 14 (6) e083230. doi : 10.1136/bmjopen-2023-083230 . PMC 11328626 . PMID 38908838 . ^ a b The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review Archived 2008-12-17 at the Wayback Machine ^ Carter (2005):98 ^ Berenson AB (April 1990). "Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents" . Obstetrics and Gynecology . 75 (4): 627– 629. PMID 2314783 . Archived from the original on 2013-11-03. ^ "Atelectasis" . The Lecturio Medical Concept Library . Retrieved 7 July 2021 . ^ "Urinary Tract Infection" . Centers for Disease Control and Prevention (CDC) . 17 April 2015. Archived from the original on 22 February 2016 . Retrieved 7 July 2021 . ^ Crum CP, Lee KR, Nucci MR (2011). Diagnostic Gynecologic and Obstetric Pathology E-Book . Elsevier Health Sciences. p. 430. ISBN 978-1-4557-0895-6 . ^ Definition of "infection" from several medical dictionaries – Retrieved on 2021-07-07 ^ Callaghan T. Blueprint Obstetrics and Gynecology . ^ Berens PD (December 2015). "Breast Pain: Engorgement, Nipple Pain, and Mastitis" . Clinical Obstetrics and Gynecology . 58 (4): 902– 14. doi : 10.1097/GRF.0000000000000153 . PMID 26512442 . S2CID 13006527 . ^ "WHO recommendations for prevention and treatment of maternal peripartum infections" (PDF) . Archived (PDF) from the original on 2016-03-06. ^ Carter KC, Carter BR (2005). Childbed fever. A scientific biography of Ignaz Semmelweis . Transaction Publishers. p. 100. ISBN 978-1-4128-0467-7 . ^ Lewis G , ed. (2007). Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom . CEMACH. p. 97. ISBN 978-0-9533536-8-2 . [ permanent dead link ] ^ CEMACH: Saving Mothers' Lives 2003–2005 Archived 2008-05-21 at the Wayback Machine ^ Loudon I (9 March 2000). The Tragedy of Childbed Fever (PDF) . Oxford University Press, USA. p. 6. ISBN 978-0-19-820499-2 . Archived from the original (PDF) on 11 February 2012. ^ The debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8. ^ Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). "Scarlet fever: a guide for general practitioners" . London Journal of Primary Care . 9 (5): 77– 79. doi : 10.1080/17571472.2017.1365677 . ISSN 1757-1472 . PMC 5649319 . PMID 29081840 . ^ Rebecca Davis (2015-01-12). "The doctor who championed hand-washing and saved women's lives" . National Public Radio . Retrieved 2025-03-14 . ^ Loudon I. "Deaths in childbed from the eighteenth century to 1935". Med History 1986; 30: 1–41 ^ Caplan CE (1995). "The Childbed Fever Mystery and the Meaning of Medical Journalism" . McGill Journal of Medicine . 1 (1). Archived from the original on 2012-07-07. ^ Wyklicky H, Skopec M (1983). "Ignaz Philipp Semmelweis, the prophet of bacteriology". Infect Control . 4 (5): 367– 370. doi : 10.1017/S0195941700059762 . PMID 6354955 . S2CID 25830725 . ^ De Costa CM (Nov 2002). " "The contagiousness of childbed fever": a short history of puerperal sepsis and its treatment" . The Medical Journal of Australia . 177 ( 11– 12): 668– 671. doi : 10.5694/j.1326-5377.2002.tb05004.x . PMID 12463995 . S2CID 12164328 . Archived from the original on 2006-12-03. ^ Gordon A (1795). A Treatise on the Epidemic Puerperal Fever of Aberdeen . London, England: G.G. and J. Robinson. pp. 63 –64. On p. 63, Gordon recognized that puerperal fever was infectious: "But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted." From p. 64: "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women." ^ "Treatise on the Epidemic of Puerperal Fever" . www.general-anaesthesia.com. Archived from the original on July 20, 2008 . Retrieved September 15, 2011 . ^ Watson (February 18, 1842). "Lectures on the principles and practice of physic: Diseases of the abdomen" . The London Medical Gazette . 29 : 801– 808. From p. 806 : "Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another." ^ The Medical Journal of Australia. "The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment" Archived 2006-12-03 at the Wayback Machine ^ Holmes OW (1842–1843). "On the contagiousness of puerperal fever" . The New England Quarterly Journal of Medicine . 1 : 503– 530. ^ Oliver Wendell Holmes: The Contagiousness of Puerperal Fever Archived 2007-02-03 at the Wayback Machine ^ (Holmes, 1842–1843), p. 510. ^ Meigs CD (1854). On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class . Philadelphia, Pennsylvania: Blanchard and Lea. p. 104 . From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: "He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean." ^ Gordon R (1983). "Disastrous Motherhood: Tales from the Vienna Wards". Great Medical Disasters . London: Hutchinson & Co. pp. 43–46 [43]. ^ Treves F (1923). "Ch. 2: The Old Receiving Room". The Elephant Man and Other Reminiscences . London, England: Cassell and Company, Ltd. pp. 56 –57. ^ Gordon, Richard (1983) p. 44 ^ Raju TN (1999). "Ignác Semmelweis and the etiology of fetal and neonatal sepsis". Journal of Perinatology . 19 (4): 307– 310. doi : 10.1038/sj.jp.7200155 . PMID 10685244 . S2CID 29047987 . ^ Christa Colyer. "Childbed fever: a nineteenth-century mystery," Archived 2009-04-16 at the Wayback Machine National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003). ^ Colebrook, L; Kenny, M (June 6, 1936). "Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil". Lancet 227 (1): 1279–1286. ^ Sue Bale, Vanessa Jones (2006). Wound care nursing . Elsevier Health Sciences. p. 54. ISBN 978-0-7234-3344-6 . Retrieved 2009-08-05 . ^ Sophie Campbell (2012-08-14). "Sudeley Castle: the curious life and death of Katherine Parr" . The Telegraph . Retrieved 2025-03-14 . ^ Quoted from Will Durant 's "The Age of Rousseau". [ full citation needed ] ^ Beetham M (2004). "Beeton, Samuel Orchart (1831–1877)" . Oxford Dictionary of National Biography (online ed.). Oxford University Press. doi : 10.1093/ref:odnb/45481 . Retrieved 23 November 2015 . {{ cite encyclopedia }} : CS1 maint: ref duplicates default ( link ) (Subscription, Wikipedia Library access or UK public library membership required.) ^ Hughes K (2006). The Short Life and Long Times of Mrs Beeton . London: HarperCollins Publishers. ISBN 978-0-7524-6122-9 . Chaim W, Burstein E (August 2003). "Postpartum infection treatments: a review". Expert Opinion on Pharmacotherapy (review). 4 (8): 1297– 313. doi : 10.1517/14656566.4.8.1297 . PMID 12877638 . S2CID 26781321 . French L (August 2003). "Prevention and treatment of postpartum endometritis". Current Women's Health Reports (review). 3 (4): 274– 9. PMID 12844449 . Calhoun BC, Brost B (June 1995). "Emergency management of sudden puerperal fever". Obstetrics and Gynecology Clinics of North America (review). 22 (2): 357– 67. doi : 10.1016/S0889-8545(21)00185-6 . PMID 7651676 .
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[o]") ## Contents move to sidebar hide - [(Top)](https://en.wikipedia.org/wiki/Postpartum_infections) - [1 Signs and symptoms](https://en.wikipedia.org/wiki/Postpartum_infections#Signs_and_symptoms) - [2 Causes](https://en.wikipedia.org/wiki/Postpartum_infections#Causes) Toggle Causes subsection - [2\.1 Risk factors](https://en.wikipedia.org/wiki/Postpartum_infections#Risk_factors) - [3 Diagnosis](https://en.wikipedia.org/wiki/Postpartum_infections#Diagnosis) Toggle Diagnosis subsection - [3\.1 Differential diagnosis](https://en.wikipedia.org/wiki/Postpartum_infections#Differential_diagnosis) - [4 Management](https://en.wikipedia.org/wiki/Postpartum_infections#Management) - [5 Epidemiology](https://en.wikipedia.org/wiki/Postpartum_infections#Epidemiology) - [6 History](https://en.wikipedia.org/wiki/Postpartum_infections#History) Toggle History subsection - [6\.1 "The Doctor's Plague"](https://en.wikipedia.org/wiki/Postpartum_infections#"The_Doctor's_Plague") - [6\.2 Hygienic measures](https://en.wikipedia.org/wiki/Postpartum_infections#Hygienic_measures) - [6\.3 Notable cases](https://en.wikipedia.org/wiki/Postpartum_infections#Notable_cases) - [7 See also](https://en.wikipedia.org/wiki/Postpartum_infections#See_also) - [8 References](https://en.wikipedia.org/wiki/Postpartum_infections#References) - [9 Further reading](https://en.wikipedia.org/wiki/Postpartum_infections#Further_reading) - [10 External links](https://en.wikipedia.org/wiki/Postpartum_infections#External_links) Toggle the table of contents # Postpartum infections 52 languages - [العربية](https://ar.wikipedia.org/wiki/%D8%AD%D9%85%D9%89_%D8%A7%D9%84%D9%86%D9%81%D8%A7%D8%B3 "حمى النفاس – Arabic") - [Azərbaycanca](https://az.wikipedia.org/wiki/Do%C4%9Fu%C5%9F_zaman%C4%B1_temperatur "Doğuş zamanı temperatur – Azerbaijani") - [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%AA%E0%A7%8D%E0%A6%B0%E0%A6%B8%E0%A7%8B%E0%A6%AC%E0%A6%A4%E0%A7%8D%E0%A6%A4%E0%A6%B0_%E0%A6%B8%E0%A6%82%E0%A6%95%E0%A7%8D%E0%A6%B0%E0%A6%AE%E0%A6%A3 "প্রসোবত্তর সংক্রমণ – Bangla") - [Català](https://ca.wikipedia.org/wiki/Infecci%C3%B3_puerperal "Infecció puerperal – Catalan") - [Čeština](https://cs.wikipedia.org/wiki/Hore%C4%8Dka_omladnic "Horečka omladnic – Czech") - [Deutsch](https://de.wikipedia.org/wiki/Kindbettfieber "Kindbettfieber – German") - [Español](https://es.wikipedia.org/wiki/Infecci%C3%B3n_puerperal "Infección puerperal – Spanish") - [Euskara](https://eu.wikipedia.org/wiki/Infekzio_puerperal "Infekzio puerperal – Basque") - [فارسی](https://fa.wikipedia.org/wiki/%D8%AA%D8%A8_%D8%B2%D8%A7%DB%8C%D9%85%D8%A7%D9%86 "تب زایمان – Persian") - [Français](https://fr.wikipedia.org/wiki/Fi%C3%A8vre_puerp%C3%A9rale "Fièvre puerpérale – French") - [Gaeilge](https://ga.wikipedia.org/wiki/Ionfhabhtuithe_iarthuismidh "Ionfhabhtuithe iarthuismidh – Irish") - [Avañe'ẽ](https://gn.wikipedia.org/wiki/Membys%E1%BA%BD_rire_p%C3%A1mo "Membysẽ rire pámo – Guarani") - [ગુજરાતી](https://gu.wikipedia.org/wiki/%E0%AA%AA%E0%AB%8D%E0%AA%B0%E0%AA%B8%E0%AB%82%E0%AA%A4%E0%AA%BF_%E0%AA%9A%E0%AB%87%E0%AA%AA%E0%AB%8B "પ્રસૂતિ ચેપો – Gujarati") - [עברית](https://he.wikipedia.org/wiki/%D7%96%D7%99%D7%94%D7%95%D7%9D_%D7%9C%D7%99%D7%93%D7%94 "זיהום לידה – Hebrew") - [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%9C%E0%A4%9A%E0%A5%8D%E0%A4%9A%E0%A4%BE_%E0%A4%B8%E0%A4%82%E0%A4%95%E0%A5%8D%E0%A4%B0%E0%A4%AE%E0%A4%A3 "जच्चा संक्रमण – Hindi") - [Hrvatski](https://hr.wikipedia.org/wiki/Babinja_groznica "Babinja groznica – Croatian") - [Magyar](https://hu.wikipedia.org/wiki/Gyermek%C3%A1gyi_l%C3%A1z "Gyermekágyi láz – Hungarian") - [Հայերեն](https://hy.wikipedia.org/wiki/%D5%80%D5%A5%D5%BF%D5%AE%D5%B6%D5%B6%D5%A4%D5%A1%D5%A2%D5%A5%D6%80%D5%A1%D5%AF%D5%A1%D5%B6_%D5%BE%D5%A1%D6%80%D5%A1%D5%AF%D5%B6%D5%A5%D6%80 "Հետծննդաբերական վարակներ – Armenian") - [Bahasa Indonesia](https://id.wikipedia.org/wiki/Demam_puerperal "Demam puerperal – Indonesian") - [Igbo](https://ig.wikipedia.org/wiki/%E1%BB%8Cr%E1%BB%8Ba_n%E2%80%99esochi_mgbe_nwaany%E1%BB%8B_m%E1%BB%A5s%E1%BB%8Br%E1%BB%8B_nwa "Ọrịa n’esochi mgbe nwaanyị mụsịrị nwa – Igbo") - [Italiano](https://it.wikipedia.org/wiki/Febbre_puerperale "Febbre puerperale – Italian") - [日本語](https://ja.wikipedia.org/wiki/%E7%94%A3%E8%A4%A5%E7%86%B1 "産褥熱 – Japanese") - [ಕನ್ನಡ](https://kn.wikipedia.org/wiki/%E0%B2%AA%E0%B2%B0%E0%B3%8D%E0%B2%AA%E0%B3%8D%E0%B2%AF%E0%B3%81%E0%B2%B0%E0%B2%BE%E0%B2%A6_%E0%B2%B8%E0%B3%8B%E0%B2%82%E0%B2%95%E0%B3%81%E0%B2%97%E0%B2%B3%E0%B3%81 "ಪರ್ಪ್ಯುರಾದ ಸೋಂಕುಗಳು – Kannada") - [한국어](https://ko.wikipedia.org/wiki/%EC%82%B0%EC%9A%95%EC%97%B4 "산욕열 – Korean") - [Lietuvių](https://lt.wikipedia.org/wiki/Postnatalin%C4%97s_infekcin%C4%97s_ligos "Postnatalinės infekcinės ligos – Lithuanian") - [Madhurâ](https://mad.wikipedia.org/wiki/Demam_puerperal "Demam puerperal – Madurese") - [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%AA%E0%B5%8B%E0%B4%B8%E0%B5%8D%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B5%8D%E2%80%8C%E0%B4%AA%E0%B4%BE%E0%B5%BC%E0%B4%9F%E0%B5%8D%E0%B4%9F%E0%B4%82_%E0%B4%85%E0%B4%A3%E0%B5%81%E0%B4%AC%E0%B4%BE%E0%B4%A7%E0%B4%95%E0%B5%BE "പോസ്റ്റ്‌പാർട്ടം അണുബാധകൾ – Malayalam") - [मराठी](https://mr.wikipedia.org/wiki/%E0%A4%AA%E0%A5%8D%E0%A4%B0%E0%A4%B8%E0%A4%B5%E0%A5%8B%E0%A4%A4%E0%A5%8D%E0%A4%A4%E0%A4%B0_%E0%A4%9C%E0%A4%82%E0%A4%A4%E0%A5%81%E0%A4%B8%E0%A4%82%E0%A4%B8%E0%A4%B0%E0%A5%8D%E0%A4%97 "प्रसवोत्तर जंतुसंसर्ग – Marathi") - [Bahasa Melayu](https://ms.wikipedia.org/wiki/Jangkitan_selepas_bersalin "Jangkitan selepas bersalin – Malay") - [မြန်မာဘာသာ](https://my.wikipedia.org/wiki/%E1%80%99%E1%80%AE%E1%80%B8%E1%80%96%E1%80%BD%E1%80%AC%E1%80%B8%E1%80%95%E1%80%BC%E1%80%AE%E1%80%B8%E1%80%9B%E1%80%B1%E1%80%AC%E1%80%82%E1%80%AB%E1%80%95%E1%80%AD%E1%80%AF%E1%80%B8%E1%80%9D%E1%80%84%E1%80%BA%E1%80%81%E1%80%BC%E1%80%84%E1%80%BA%E1%80%B8 "မီးဖွားပြီးရောဂါပိုးဝင်ခြင်း – Burmese") - [Nederlands](https://nl.wikipedia.org/wiki/Kraamvrouwenkoorts "Kraamvrouwenkoorts – Dutch") - [Norsk bokmål](https://no.wikipedia.org/wiki/Barselfeber "Barselfeber – Norwegian Bokmål") - [Chi-Chewa](https://ny.wikipedia.org/wiki/Matenda_oyamba_chifukwa_cha_uchembere "Matenda oyamba chifukwa cha uchembere – Nyanja") - [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%AA%E0%AD%8D%E0%AC%B0%E0%AC%B8%E0%AC%AC_%E0%AC%B8%E0%AC%82%E0%AC%95%E0%AD%8D%E0%AC%B0%E0%AC%AE%E0%AC%A3 "ପ୍ରସବ ସଂକ୍ରମଣ – Odia") - [Polski](https://pl.wikipedia.org/wiki/Zaka%C5%BCenie_po%C5%82ogowe "Zakażenie połogowe – Polish") - [Português](https://pt.wikipedia.org/wiki/Infe%C3%A7%C3%A3o_puerperal "Infeção puerperal – Portuguese") - [Română](https://ro.wikipedia.org/wiki/Febr%C4%83_puerperal%C4%83 "Febră puerperală – Romanian") - [Русский](https://ru.wikipedia.org/wiki/%D0%A0%D0%BE%D0%B4%D0%B8%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%B3%D0%BE%D1%80%D1%8F%D1%87%D0%BA%D0%B0 "Родильная горячка – Russian") - [Srpskohrvatski / српскохрватски](https://sh.wikipedia.org/wiki/Porodiljska_groznica "Porodiljska groznica – Serbo-Croatian") - [Simple English](https://simple.wikipedia.org/wiki/Childbed_fever "Childbed fever – Simple English") - [ChiShona](https://sn.wikipedia.org/wiki/Utachiona_hwemunzira_inobuda_nemwana "Utachiona hwemunzira inobuda nemwana – Shona") - [Српски / srpski](https://sr.wikipedia.org/wiki/Porodiljska_groznica "Porodiljska groznica – Serbian") - [Sesotho](https://st.wikipedia.org/wiki/Ditshwaetso_tsa_ka_mora_ho_beleha "Ditshwaetso tsa ka mora ho beleha – Southern Sotho") - [Svenska](https://sv.wikipedia.org/wiki/Barns%C3%A4ngsfeber "Barnsängsfeber – Swedish") - [தமிழ்](https://ta.wikipedia.org/wiki/%E0%AE%AA%E0%AE%BF%E0%AE%B0%E0%AE%9A%E0%AE%B5%E0%AE%A4%E0%AF%8D%E0%AE%A4%E0%AF%81%E0%AE%95%E0%AF%8D%E0%AE%95%E0%AF%81%E0%AE%AA%E0%AF%8D_%E0%AE%AA%E0%AE%BF%E0%AE%A8%E0%AF%8D%E0%AE%A4%E0%AF%88%E0%AE%AF%E0%AE%A4%E0%AF%8D_%E0%AE%A4%E0%AF%8A%E0%AE%B1%E0%AF%8D%E0%AE%B1%E0%AF%81%E0%AE%95%E0%AE%B3%E0%AF%8D "பிரசவத்துக்குப் பிந்தையத் தொற்றுகள் – Tamil") - [తెలుగు](https://te.wikipedia.org/wiki/%E0%B0%AA%E0%B1%8D%E0%B0%B0%E0%B0%B8%E0%B1%82%E0%B0%A4%E0%B0%BF_%E0%B0%87%E0%B0%A8%E0%B1%8D%E0%B0%AB%E0%B1%86%E0%B0%95%E0%B1%8D%E0%B0%B7%E0%B0%A8%E0%B1%8D%E0%B0%B2%E0%B1%81 "ప్రసూతి ఇన్ఫెక్షన్లు – Telugu") - [Twi](https://tw.wikipedia.org/wiki/Awo_akyi_nyarewa "Awo akyi nyarewa – Twi") - [Українська](https://uk.wikipedia.org/wiki/%D0%9F%D0%BE%D0%BB%D0%BE%D0%B3%D0%BE%D0%B2%D0%B0_%D0%B3%D0%B0%D1%80%D1%8F%D1%87%D0%BA%D0%B0 "Пологова гарячка – Ukrainian") - [اردو](https://ur.wikipedia.org/wiki/%D8%AD%D9%85%DB%8C%D9%B0_%D9%86%D9%81%D8%A7%D8%B3%DB%8C%DB%81 "حمیٰ نفاسیہ – Urdu") - [Tiếng Việt](https://vi.wikipedia.org/wiki/Nhi%E1%BB%85m_tr%C3%B9ng_sau_sinh "Nhiễm trùng sau sinh – Vietnamese") - [粵語](https://zh-yue.wikipedia.org/wiki/%E7%94%A2%E5%BE%8C%E6%84%9F%E6%9F%93 "產後感染 – Cantonese") - [中文](https://zh.wikipedia.org/wiki/%E4%BA%A7%E8%A4%A5%E7%83%AD "产褥热 – Chinese") [Edit links](https://www.wikidata.org/wiki/Special:EntityPage/Q1419347#sitelinks-wikipedia "Edit interlanguage links") - [Article](https://en.wikipedia.org/wiki/Postpartum_infections "View the content page [c]") - [Talk](https://en.wikipedia.org/wiki/Talk:Postpartum_infections "Discuss improvements to the content page [t]") English - [Read](https://en.wikipedia.org/wiki/Postpartum_infections) - [Edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit "Edit this page [e]") - [View history](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=history "Past revisions of this page [h]") Tools Tools move to sidebar hide Actions - 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\| Postpartum infections \| \| \|---\|---\| \| Other names \| Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections \| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/e/e4/Streptococcus_pyogenes.jpg/250px-Streptococcus_pyogenes.jpg)](https://en.wikipedia.org/wiki/File:Streptococcus_pyogenes.jpg) \| \| \| [Streptococcus pyogenes](https://en.wikipedia.org/wiki/Streptococcus_pyogenes "Streptococcus pyogenes") (red-stained spheres) is responsible for many cases of severe puerperal fever. \| \| \| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") \| [Obstetrics](https://en.wikipedia.org/wiki/Obstetrics "Obstetrics") \| \| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") \| Fever, lower abdominal pain, bad-smelling vaginal discharge[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") \| Typically multiple types of bacteria[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") \| [Caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section"), [premature rupture of membranes](https://en.wikipedia.org/wiki/Premature_rupture_of_membranes "Premature rupture of membranes"), [prolonged labour](https://en.wikipedia.org/wiki/Prolonged_labour "Prolonged labour"), [malnutrition](https://en.wikipedia.org/wiki/Malnutrition "Malnutrition"), [diabetes](https://en.wikipedia.org/wiki/Diabetes "Diabetes")[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) \| \| Treatment \| [Antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics")[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| Frequency \| 11\.8 million[\[3\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015Pre-3) \| \| Deaths \| 17,900[\[4\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015De-4) \| Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial [infections](https://en.wikipedia.org/wiki/Infection "Infection") of the [female reproductive tract](https://en.wikipedia.org/wiki/Female_reproductive_tract "Female reproductive tract") following [childbirth](https://en.wikipedia.org/wiki/Childbirth "Childbirth") or [miscarriage](https://en.wikipedia.org/wiki/Miscarriage "Miscarriage").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Signs and symptoms usually include a [fever](https://en.wikipedia.org/wiki/Fever "Fever") greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous [vaginal discharge](https://en.wikipedia.org/wiki/Vaginal_discharge "Vaginal discharge").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\[5\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hir2014-5) The most common infection is that of the [uterus](https://en.wikipedia.org/wiki/Uterus "Uterus") and surrounding tissues known as puerperal sepsis, postpartum metritis, or postpartum endometritis.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[6\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hac2015-6) Risk factors include [caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section") (C-section), the presence of certain bacteria such as [group B streptococcus](https://en.wikipedia.org/wiki/Group_B_streptococcus "Group B streptococcus") in the vagina, [premature rupture of membranes](https://en.wikipedia.org/wiki/Premature_rupture_of_membranes "Premature rupture of membranes"), multiple [vaginal exams](https://en.wikipedia.org/wiki/Vaginal_exam "Vaginal exam"), manual removal of the [placenta](https://en.wikipedia.org/wiki/Placenta "Placenta"), and [prolonged labour](https://en.wikipedia.org/wiki/Prolonged_labour "Prolonged labour") among others.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) Most infections involve a number of types of bacteria.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Diagnosis is rarely helped by [culturing](https://en.wikipedia.org/wiki/Microbiological_culture "Microbiological culture") of the vagina or blood.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those who do not improve, [medical imaging](https://en.wikipedia.org/wiki/Medical_imaging "Medical imaging") may be required.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Other causes of fever following delivery include [breast engorgement](https://en.wikipedia.org/wiki/Breast_engorgement "Breast engorgement"), [urinary tract infections](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"), infections of an abdominal incision or an [episiotomy](https://en.wikipedia.org/wiki/Episiotomy "Episiotomy"), and [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) Due to the risks following caesarean section, it is recommended that all women receive a preventive dose of [antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic") such as [ampicillin](https://en.wikipedia.org/wiki/Ampicillin "Ampicillin") around the time of surgery.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Treatment of established infections is with antibiotics, with most people improving in two to three days.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those with mild disease, oral antibiotics may be used; otherwise, [intravenous](https://en.wikipedia.org/wiki/Intravenous "Intravenous") antibiotics are recommended.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Common antibiotics include a combination of ampicillin and [gentamicin](https://en.wikipedia.org/wiki/Gentamicin "Gentamicin") following vaginal delivery or [clindamycin](https://en.wikipedia.org/wiki/Clindamycin "Clindamycin") and gentamicin in those who have had a C-section.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those who are not improving with appropriate treatment, other complications such as an [abscess](https://en.wikipedia.org/wiki/Abscess "Abscess") should be considered.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In 2015, about 11.8 million maternal infections occurred.[\[3\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015Pre-3) In the developed world about 1% to 2% develop uterine infections following [vaginal delivery](https://en.wikipedia.org/wiki/Vaginal_delivery "Vaginal delivery").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[\[4\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015De-4)[\[7\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GDB2013-7) They are the cause of about 10% of deaths around the time of pregnancy.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) The first known descriptions of the condition date back to at least the 5th century BCE in the writings of [Hippocrates](https://en.wikipedia.org/wiki/Hippocrates "Hippocrates").[\[8\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-8) These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[\[9\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-9) In 1847, Hungarian physician [Ignaz Semmelweiss](https://en.wikipedia.org/wiki/Ignaz_Semmelweiss "Ignaz Semmelweiss") decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of [handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing") with [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite").[\[10\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-10)[\[11\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-11) ## Signs and symptoms \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=1 "Edit section: Signs and symptoms")\] Signs and symptoms usually include a [fever](https://en.wikipedia.org/wiki/Fever "Fever") greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\[5\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hir2014-5) ## Causes \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=2 "Edit section: Causes")\] After childbirth, the [female genital tract](https://en.wikipedia.org/wiki/Female_reproductive_system "Female reproductive system") has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the [uterus](https://en.wikipedia.org/wiki/Uterus "Uterus"), or it may spread beyond to cause [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis") or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the [placenta](https://en.wikipedia.org/wiki/Placenta "Placenta") (afterbirth), but [pathogenic](https://en.wikipedia.org/wiki/Pathogenic "Pathogenic") organisms may also affect [lacerations](https://en.wikipedia.org/wiki/Lacerations "Lacerations") of any part of the genital tract. By whatever portal, they can invade the [bloodstream](https://en.wikipedia.org/wiki/Bloodstream "Bloodstream") and [lymph system](https://en.wikipedia.org/wiki/Lymph_system "Lymph system") to cause [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis"), [cellulitis](https://en.wikipedia.org/wiki/Cellulitis "Cellulitis") (inflammation of connective tissue), and pelvic or generalized [peritonitis](https://en.wikipedia.org/wiki/Peritonitis "Peritonitis") (inflammation of the abdominal lining). The severity of the illness depends on the [virulence](https://en.wikipedia.org/wiki/Virulence "Virulence") of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are [Streptococcus pyogenes](https://en.wikipedia.org/wiki/Streptococcus_pyogenes "Streptococcus pyogenes"); [staphylococci](https://en.wikipedia.org/wiki/Staphylococci "Staphylococci") (inhabitants of the skin and of [pimples](https://en.wikipedia.org/wiki/Pimples "Pimples"), [carbuncles](https://en.wikipedia.org/wiki/Carbuncles "Carbuncles"), and many other [pustular](https://en.wikipedia.org/wiki/Pustular "Pustular") eruptions); the [anaerobic streptococci](https://en.wikipedia.org/wiki/Peptostreptococcus "Peptostreptococcus"), which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; [Escherichia coli](https://en.wikipedia.org/wiki/Escherichia_coli "Escherichia coli")[\[12\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-12) and [Clostridium perfringens](https://en.wikipedia.org/wiki/Clostridium_perfringens "Clostridium perfringens") (inhabitants of the lower bowel); and [Clostridium tetani](https://en.wikipedia.org/wiki/Clostridium_tetani "Clostridium tetani").[\[13\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-13) ### Risk factors \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=3 "Edit section: Risk factors")\] Causes (listed in order of decreasing frequency) include: [endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis"), [urinary tract infection](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"), [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia")/[atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"), [wound infection](https://en.wikipedia.org/wiki/Wound_infection "Wound infection"), and [septic pelvic thrombophlebitis](https://en.wikipedia.org/wiki/Septic_pelvic_thrombophlebitis "Septic pelvic thrombophlebitis"). Sepsis risk factors for each condition are listed in order of the [postpartum](https://en.wikipedia.org/wiki/Postpartum "Postpartum") day (PPD) on which the condition generally occurs.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] - PPD 0: [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis") risk factors include [general anesthesia](https://en.wikipedia.org/wiki/General_anesthesia "General anesthesia"), [cigarette smoking](https://en.wikipedia.org/wiki/Cigarette_smoking "Cigarette smoking"), and [obstructive lung disease](https://en.wikipedia.org/wiki/Obstructive_lung_disease "Obstructive lung disease"). - PPD 1–2: urinary tract infection risk factors include multiple [catheterization](https://en.wikipedia.org/wiki/Catheterization "Catheterization") during labor, multiple [vaginal examinations](https://en.wikipedia.org/wiki/Vaginal_examination "Vaginal examination") during labor, and untreated [bacteriuria](https://en.wikipedia.org/wiki/Bacteriuria "Bacteriuria"). - PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor. - PPD 4–5: wound infection risk factors include emergency [cesarean section](https://en.wikipedia.org/wiki/Cesarean_section "Cesarean section"), prolonged [membrane rupture](https://en.wikipedia.org/wiki/Membrane_rupture "Membrane rupture"), prolonged labor, and multiple vaginal examinations during labor. - PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth. - PPD 7–21: [mastitis](https://en.wikipedia.org/wiki/Mastitis "Mastitis") risk factors include nipple trauma from [breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding"). ## Diagnosis \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=4 "Edit section: Diagnosis")\] Puerperal fever is diagnosed with: - A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10) - Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)[\[14\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-gfmer.ch-14) Puerperal fever (from the Latin puer, male child (boy)), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:[\[15\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-15) 1. the specific target of infection: [endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis") (inflammation of the inner lining of the uterus), [metrophlebitis](https://en.wikipedia.org/w/index.php?title=Metrophlebitis&action=edit&redlink=1 "Metrophlebitis (page does not exist)") (inflammation of the veins of the uterus), and [peritonitis](https://en.wikipedia.org/wiki/Peritonitis "Peritonitis") (inflammation of the membrane lining of the abdomen). 2. the severity of the infection: less serious [infection](https://en.wikipedia.org/wiki/Infection "Infection") (contained multiplication of microbes) or possibly life-threatening [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis") (uncontrolled and uncontained multiplication of microbes throughout the bloodstream). [Endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis") is a polymicrobial infection. It frequently includes organisms such as [Ureaplasma](https://en.wikipedia.org/wiki/Ureaplasma "Ureaplasma"), [Streptococcus](https://en.wikipedia.org/wiki/Streptococcus "Streptococcus"), [Mycoplasma](https://en.wikipedia.org/wiki/Mycoplasma "Mycoplasma"), and [Bacteroides](https://en.wikipedia.org/wiki/Bacteroides "Bacteroides"), and may also include organisms such as [Gardnerella](https://en.wikipedia.org/wiki/Gardnerella "Gardnerella"), [Chlamydia](https://en.wikipedia.org/wiki/Chlamydia_\(bacterium\) "Chlamydia (bacterium)"), [Lactobacillus](https://en.wikipedia.org/wiki/Lactobacillus "Lactobacillus"), [Escherichia](https://en.wikipedia.org/wiki/Escherichia "Escherichia"), and [Staphylococcus](https://en.wikipedia.org/wiki/Staphylococcus "Staphylococcus").[\[16\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-16) ### Differential diagnosis \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=5 "Edit section: Differential diagnosis")\] Several other conditions can cause fevers following delivery, including: [urinary tract infections](https://en.wikipedia.org/wiki/Urinary_tract_infections "Urinary tract infections"), [breast engorgement](https://en.wikipedia.org/wiki/Breast_engorgement "Breast engorgement"), [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"), and surgical incisions, among others.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) ## Management \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=6 "Edit section: Management")\] Antibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) [Atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"): mild to moderate fever, no changes or mild rales on chest [auscultation](https://en.wikipedia.org/wiki/Auscultation "Auscultation").[\[17\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-17) Management: pulmonary exercises, ambulation (deep breathing and walking). [Urinary tract infection](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"): high fever, malaise, [costovertebral](https://en.wikipedia.org/wiki/Costovertebral_angle_tenderness "Costovertebral angle tenderness") tenderness, positive urine culture.[\[18\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-18) Management: antibiotics as per culture sensitivity (cephalosporin). [Endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis"): moderate fever, exquisite uterine tenderness, minimal abdominal findings.[\[19\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-19) Management: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary. [Wound infection](https://en.wikipedia.org/wiki/Wound_infection "Wound infection"): persistent spiking fever despite antibiotics, wound [erythema](https://en.wikipedia.org/wiki/Erythema "Erythema") or fluctuance, wound drainage.[\[20\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-20) Management: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure. [Septic pelvic thrombophlebitis](https://en.wikipedia.org/wiki/Septic_pelvic_thrombophlebitis "Septic pelvic thrombophlebitis"): persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.[\[21\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-21) Management: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values. [Mastitis](https://en.wikipedia.org/wiki/Mastitis "Mastitis"): unilateral, localized erythema, [edema](https://en.wikipedia.org/wiki/Edema "Edema"), tenderness.[\[22\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-22) Management: antibiotics for cellulitis, open and drain the abscess if present. ## Epidemiology \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=7 "Edit section: Epidemiology")\] The number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.[\[14\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-gfmer.ch-14) Globally, bacterial infections are the cause of 10% of [maternal deaths](https://en.wikipedia.org/wiki/Maternal_death "Maternal death")—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2)[\[23\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-23) In the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is [caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section").[\[24\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-24) The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In the United Kingdom from 1985 to 2005, the number of direct deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.[\[25\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-25) In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.[\[26\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-26) Puerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to [childbirth](https://en.wikipedia.org/wiki/Childbirth "Childbirth"), and was second only to [tuberculosis](https://en.wikipedia.org/wiki/Tuberculosis "Tuberculosis") in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.[\[27\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-27) ## History \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=8 "Edit section: History")\] Although it had been recognized from as early as the time of the [Hippocratic corpus](https://en.wikipedia.org/wiki/Hippocratic_corpus "Hippocratic corpus") that women in childbed were prone to fevers, the distinct name "puerperal fever" appears in historical records only from the early 18th century.[\[28\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-28) The death rate for women giving birth decreased in the 20th century in [developed countries](https://en.wikipedia.org/wiki/Developed_countries "Developed countries"). The decline may be partly attributed to improved environmental conditions, better [obstetrical](https://en.wikipedia.org/wiki/Obstetrical "Obstetrical") care, and the use of [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics"). Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of [scarlet fever](https://en.wikipedia.org/wiki/Scarlet_fever "Scarlet fever"), which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.[\[29\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-29) ### "The Doctor's Plague" \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=9 "Edit section: \"The Doctor's Plague\"")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Yearly_mortality_rates_1784-1849.png/330px-Yearly_mortality_rates_1784-1849.png)](https://en.wikipedia.org/wiki/File:Yearly_mortality_rates_1784-1849.png) In his 1861 book, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") presented evidence to demonstrate that the advent of [pathological anatomy](https://en.wikipedia.org/wiki/Pathological_anatomy "Pathological anatomy") in Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of [chlorine](https://en.wikipedia.org/wiki/Chlorine "Chlorine") handwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison ([view rates](https://en.wikipedia.org/wiki/Historical_mortality_rates_of_puerperal_fever#Yearly_mortality_rates_for_birth_giving_women_1784-1849 "Historical mortality rates of puerperal fever")). His efforts were futile, however. From the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of [germs](https://en.wikipedia.org/wiki/Microorganism "Microorganism"), doctors did not believe hand washing was needed.[\[30\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-30) Hospitals for childbirth became common in the 17th century in many European cities. These "lying-in" hospitals were established at a time when there was no knowledge of [antisepsis](https://en.wikipedia.org/wiki/Antisepsis "Antisepsis") or [epidemiology](https://en.wikipedia.org/wiki/Epidemiology "Epidemiology"), and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] The first recorded epidemic of puerperal fever occurred at the [Hôtel-Dieu de Paris](https://en.wikipedia.org/wiki/H%C3%B4tel-Dieu_de_Paris "Hôtel-Dieu de Paris") in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.[\[31\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-31) In the early 19th century, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a [maternity ward](https://en.wikipedia.org/wiki/Maternity_ward "Maternity ward"). His investigation discovered that washing hands before a delivery with a [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite") solution reduced childbed fever fatalities by 90%.[\[32\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-32) His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.[\[33\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Ignaz_Semmelweis-33) The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.[\[34\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-childbed_fever-34) Semmelweis was not the only doctor ignored after sounding a warning about the problem. In his Treatise on the Epidemic of Puerperal Fever (1795), ex-naval surgeon and [Aberdonian](https://en.wikipedia.org/wiki/Aberdeen "Aberdeen") obstetrician [Alexander Gordon](https://en.wikipedia.org/wiki/Alexander_Gordon_\(physician\) "Alexander Gordon (physician)") (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women."[\[35\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-35)[\[36\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Dr_Alexander_Gordon-36) In 1842, [Thomas Watson](https://en.wikipedia.org/wiki/Sir_Thomas_Watson,_1st_Baronet "Sir Thomas Watson, 1st Baronet") (1792–1882), a professor of medicine at [King's College Hospital](https://en.wikipedia.org/wiki/King%27s_College_Hospital "King's College Hospital"), London, wrote: "Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent [ablution](https://en.wikipedia.org/wiki/Hygiene "Hygiene")." Watson recommended [handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing") with [chlorine](https://en.wikipedia.org/wiki/Chlorine "Chlorine") solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another."[\[37\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-37)[\[38\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-38) ### Hygienic measures \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=10 "Edit section: Hygienic measures")\] In 1843, [Oliver Wendell Holmes Sr.](https://en.wikipedia.org/wiki/Oliver_Wendell_Holmes_Sr. "Oliver Wendell Holmes Sr.") published The Contagiousness of Puerperal Fever and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.[\[39\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-39)[\[40\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-bartleby.com-40) Holmes quoted Dr. James Blundell as stating, "... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease."[\[41\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-41) Holmes' conclusions were ridiculed by many contemporaries, including [Charles Delucena Meigs](https://en.wikipedia.org/wiki/Charles_Delucena_Meigs "Charles Delucena Meigs"), a well-known obstetrician, who stated, "Doctors are gentlemen, and gentlemen's hands are clean."[\[42\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-42) Richard Gordon states that Holmes' exhortations "outraged obstetricians, particularly in Philadelphia".[\[43\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GordononMotherhood-43) In those days, "surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "cleanliness was next to prudishness". He quotes [Sir Frederick Treves](https://en.wikipedia.org/wiki/Sir_Frederick_Treves,_1st_Baronet "Sir Frederick Treves, 1st Baronet") on that era: "There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head."[\[44\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-44)[\[45\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GordononMotherhood44-45) In 1844, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") was appointed assistant lecturer in the First Obstetric Division of the [Vienna General Hospital](https://en.wikipedia.org/wiki/Vienna_General_Hospital "Vienna General Hospital") (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, [Jakob Kolletschka](https://en.wikipedia.org/wiki/Jakob_Kolletschka "Jakob Kolletschka"), died of sepsis after a student accidentally cut his hand while performing an autopsy.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.[\[46\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-raju-46) While his results were extraordinary, he was treated with skepticism and ridicule (see [Response to Semmelweis](https://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz_Semmelweis "Contemporary reaction to Ignaz Semmelweis")). He did the same work in St. Rochus hospital in [Pest, Hungary](https://en.wikipedia.org/wiki/Pest,_Hungary "Pest, Hungary"), and published his findings in 1860, but his discovery was again ignored.[\[47\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-colyer-47) In 1935, [Leonard Colebrook](https://en.wikipedia.org/wiki/Leonard_Colebrook "Leonard Colebrook") showed [Prontosil](https://en.wikipedia.org/wiki/Prontosil "Prontosil") was effective against [haemolytic](https://en.wikipedia.org/wiki/Haemolysis "Haemolysis") [streptococcus](https://en.wikipedia.org/wiki/Streptococcus "Streptococcus") and hence a cure for puerperal fever.[\[48\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-48)[\[49\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-49) ### Notable cases \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=11 "Edit section: Notable cases")\] See also: [List of women who died in childbirth](https://en.wikipedia.org/wiki/List_of_women_who_died_in_childbirth "List of women who died in childbirth") Elite status was no protection against postpartum infections, as the deaths of several English queens attest. [Elizabeth of York](https://en.wikipedia.org/wiki/Elizabeth_of_York "Elizabeth of York"), queen consort of [Henry VII](https://en.wikipedia.org/wiki/Henry_VII_of_England "Henry VII of England"), died of puerperal fever one week after giving birth to a daughter, who also died. Her son [Henry VIII](https://en.wikipedia.org/wiki/Henry_VIII "Henry VIII") had two wives who died this way, [Jane Seymour](https://en.wikipedia.org/wiki/Jane_Seymour "Jane Seymour")\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] and [Catherine Parr](https://en.wikipedia.org/wiki/Catherine_Parr "Catherine Parr").[\[50\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-50) Suzanne Barnard, mother of philosopher [Jean-Jacques Rousseau](https://en.wikipedia.org/wiki/Jean-Jacques_Rousseau "Jean-Jacques Rousseau"), contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that "I came into the world with so few signs of life that little hope was entertained of preserving me". He was nursed back to health by an aunt.[\[51\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-51) French natural philosopher [Émilie du Châtelet](https://en.wikipedia.org/wiki/%C3%89milie_du_Ch%C3%A2telet "Émilie du Châtelet") died in 1749. [Mary Wollstonecraft](https://en.wikipedia.org/wiki/Mary_Wollstonecraft "Mary Wollstonecraft"), author of [Vindication of the Rights of Woman](https://en.wikipedia.org/wiki/Vindication_of_the_Rights_of_Woman "Vindication of the Rights of Woman"), died ten days after giving birth to [her second daughter](https://en.wikipedia.org/wiki/Mary_Shelley "Mary Shelley"), who grew up to write [Frankenstein](https://en.wikipedia.org/wiki/Frankenstein "Frankenstein"). Other notables include African-American poet [Phillis Wheatley](https://en.wikipedia.org/wiki/Phillis_Wheatley "Phillis Wheatley") (1784), British housekeeping authority [Isabella Beeton](https://en.wikipedia.org/wiki/Isabella_Beeton "Isabella Beeton") (1865),[\[52\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-52)[\[53\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-53) and American author [Jean Webster](https://en.wikipedia.org/wiki/Jean_Webster "Jean Webster") in 1916 died of puerperal fever.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] In [Charles Dickens](https://en.wikipedia.org/wiki/Charles_Dickens "Charles Dickens")' novel [A Christmas Carol](https://en.wikipedia.org/wiki/A_Christmas_Carol "A Christmas Carol"), it is implied that both [Scrooge's](https://en.wikipedia.org/wiki/Ebenezer_Scrooge "Ebenezer Scrooge") mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\]. ## See also \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=12 "Edit section: See also")\] - [Postpartum confinement](https://en.wikipedia.org/wiki/Postpartum_confinement "Postpartum confinement"), a traditional practice after childbirth ## References \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=13 "Edit section: References")\] 1. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-1) [c](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-2) [d](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-3) [e](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-4) [f](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-5) [g](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-6) [h](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-7) [i](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-8) [j](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-9) [k](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-10) [l](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-11) [m](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-12) [n](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-13) [o](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-14) [p](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-15) [q](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-16) [r](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-17) [s](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-18) [t](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-19) [u](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-20) [v](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-21) "37". Williams Obstetrics* (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-07-179893-8](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-179893-8 "Special:BookSources/978-0-07-179893-8") . 2. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-1) [c](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-2) [d](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-3) [e](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-4) [f](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-5) [g](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-6) [WHO recommendations for prevention and treatment of maternal peripartum infections](http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf) (PDF). World Health Organization. 2015. p. 1. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-92-4-154936-3](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-154936-3 "Special:BookSources/978-92-4-154936-3") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26598777](https://pubmed.ncbi.nlm.nih.gov/26598777). [Archived](https://web.archive.org/web/20160207091250/http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf) (PDF) from the original on 2016-02-07. 3. ^ [a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015Pre_3-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015Pre_3-1) GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). ["Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). Lancet. 388* (10053): 1545–1602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)31678-6](https://doi.org/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5055577](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733282](https://pubmed.ncbi.nlm.nih.gov/27733282). 4. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015De_4-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015De_4-1) GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). ["Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903). Lancet. 388* (10053): 1459–1544\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/s0140-6736(16)31012-1](https://doi.org/10.1016%2Fs0140-6736%2816%2931012-1). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5388903](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733281](https://pubmed.ncbi.nlm.nih.gov/27733281). 5. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hir2014_5-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hir2014_5-1) Hiralal Konar (2014). [DC Dutta's Textbook of Obstetrics](https://books.google.com/books?id=LU2VAwAAQBAJ&pg=PA432). JP Medical Ltd. p. 432. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-93-5152-067-2](https://en.wikipedia.org/wiki/Special:BookSources/978-93-5152-067-2 "Special:BookSources/978-93-5152-067-2") . [Archived](https://web.archive.org/web/20151208041911/https://books.google.ca/books?id=LU2VAwAAQBAJ&pg=PA432) from the original on 2015-12-08. 6. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hac2015_6-0)* "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-7558-3](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-7558-3 "Special:BookSources/978-1-4557-7558-3") . 7. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GDB2013_7-0) GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). ["Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604). Lancet. 385 (9963): 117–171\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(14)61682-2](https://doi.org/10.1016%2FS0140-6736%2814%2961682-2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4340604](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25530442](https://pubmed.ncbi.nlm.nih.gov/25530442). 8. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-8) Walvekar V (2005). [Manual of perinatal infections](https://books.google.com/books?id=DIOmY2ROeVAC&pg=PA152). New Delhi: Jaypee Bros. p. 153. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-81-8061-472-9](https://en.wikipedia.org/wiki/Special:BookSources/978-81-8061-472-9 "Special:BookSources/978-81-8061-472-9") . [Archived](https://web.archive.org/web/20160304220030/https://books.google.ca/books?id=DIOmY2ROeVAC&pg=PA152) from the original on 2016-03-04. 9. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-9) Magner LN (1992). [A history of medicine](https://archive.org/details/historyofmedicin0000magn). New York: Dekker. pp. [257](https://archive.org/details/historyofmedicin0000magn/page/257)–258. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-8247-8673-1](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8247-8673-1 "Special:BookSources/978-0-8247-8673-1") . 10. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-10) Anderson BL (April 2014). "Puerperal group A streptococcal infection: beyond Semmelweis". Obstetrics and Gynecology. 123 (4): 874–882\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/aog.0000000000000175](https://doi.org/10.1097%2Faog.0000000000000175). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24785617](https://pubmed.ncbi.nlm.nih.gov/24785617). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [24685091](https://api.semanticscholar.org/CorpusID:24685091). 11. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-11) Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). ["Medicine in stamps-Ignaz Semmelweis and Puerperal Fever"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728). Journal of the Turkish German Gynecological Association. 14 (1): 35–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5152/jtgga.2013.08](https://doi.org/10.5152%2Fjtgga.2013.08). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3881728](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24592068](https://pubmed.ncbi.nlm.nih.gov/24592068). 12. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-12) Andy W Wong (2024-03-27). ["Postpartum Infections"](https://emedicine.medscape.com/article/796892-overview). Medscape. Retrieved 2025-03-14. 13. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-13) Befekadu Tesfaye Oyato (2024-06-20). ["Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328626). BMJ Open. 14 (6) e083230. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmjopen-2023-083230](https://doi.org/10.1136%2Fbmjopen-2023-083230). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [11328626](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328626). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [38908838](https://pubmed.ncbi.nlm.nih.gov/38908838). 14. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-gfmer.ch_14-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-gfmer.ch_14-1) [The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review](http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf) [Archived](https://web.archive.org/web/20081217023721/http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf) 2008-12-17 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 15. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-15)* Carter (2005):98 16. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-16) Berenson AB (April 1990). ["Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents"](http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx). Obstetrics and Gynecology. 75 (4): 627–629\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [2314783](https://pubmed.ncbi.nlm.nih.gov/2314783). [Archived](https://web.archive.org/web/20131103084443/http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx) from the original on 2013-11-03. 17. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-17) ["Atelectasis"](https://www.lecturio.com/concepts/atelectasis/). The Lecturio Medical Concept Library. Retrieved 7 July 2021. 18. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-18) ["Urinary Tract Infection"](https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html). [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC). 17 April 2015. [Archived](https://web.archive.org/web/20160222034940/http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html) from the original on 22 February 2016. Retrieved 7 July 2021. 19. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-19) Crum CP, Lee KR, Nucci MR (2011). [Diagnostic Gynecologic and Obstetric Pathology E-Book](https://books.google.com/books?id=d91mO9WYtPYC&pg=PA430). Elsevier Health Sciences. p. 430. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-0895-6](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-0895-6 "Special:BookSources/978-1-4557-0895-6") . 20. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-20) [Definition of "infection" from several medical dictionaries](http://medical-dictionary.thefreedictionary.com/infection) – Retrieved on 2021-07-07 21. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-21) Callaghan T. Blueprint Obstetrics and Gynecology. 22. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-22) Berens PD (December 2015). ["Breast Pain: Engorgement, Nipple Pain, and Mastitis"](https://semanticscholar.org/paper/a3f96251efd59a92f82ed618dda1fea955027fbe). Clinical Obstetrics and Gynecology. 58 (4): 902–14\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/GRF.0000000000000153](https://doi.org/10.1097%2FGRF.0000000000000153). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26512442](https://pubmed.ncbi.nlm.nih.gov/26512442). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [13006527](https://api.semanticscholar.org/CorpusID:13006527). 23. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-23) ["WHO recommendations for prevention and treatment of maternal peripartum infections"](http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1) (PDF). [Archived](https://web.archive.org/web/20160306061338/http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1) (PDF) from the original on 2016-03-06. 24. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-24) Carter KC, Carter BR (2005). Childbed fever. A scientific biography of Ignaz Semmelweis. Transaction Publishers. p. 100. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4128-0467-7](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4128-0467-7 "Special:BookSources/978-1-4128-0467-7") . 25. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-25) [Lewis G](https://en.wikipedia.org/wiki/Gwyneth_Lewis_\(scientist\) "Gwyneth Lewis (scientist)"), ed. (2007). [Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom](http://www.cemach.org.uk/getattachment/8f5c1ed8-fdf3-489b-a182-e53955bec07b/Saving-Mothers--Lives-2003%E2%80%932005_full.aspx). CEMACH. p. 97. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-9533536-8-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-9533536-8-2 "Special:BookSources/978-0-9533536-8-2") . \[[permanent dead link](https://en.wikipedia.org/wiki/Wikipedia:Link_rot "Wikipedia:Link rot")\] 26. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-26) [CEMACH: Saving Mothers' Lives 2003–2005](http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx) [Archived](https://web.archive.org/web/20080521093900/http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx) 2008-05-21 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 27. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-27) [Loudon I](https://en.wikipedia.org/wiki/Irvine_Loudon "Irvine Loudon") (9 March 2000). [The Tragedy of Childbed Fever](https://web.archive.org/web/20120211075531/http://fds.oup.com/www.oup.co.uk/pdf/0-19-820499-X.pdf) (PDF). Oxford University Press, USA. p. 6. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-19-820499-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-820499-2 "Special:BookSources/978-0-19-820499-2") . Archived from [the original](http://fds.oup.com/www.oup.co.uk/pdf/0-19-820499-X.pdf) (PDF) on 11 February 2012. 28. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-28) The debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8. 29. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-29) Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). ["Scarlet fever: a guide for general practitioners"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319). London Journal of Primary Care. 9 (5): 77–79\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/17571472.2017.1365677](https://doi.org/10.1080%2F17571472.2017.1365677). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1757-1472](https://search.worldcat.org/issn/1757-1472). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5649319](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29081840](https://pubmed.ncbi.nlm.nih.gov/29081840). 30. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-30) Rebecca Davis (2015-01-12). ["The doctor who championed hand-washing and saved women's lives"](https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives). [National Public Radio](https://en.wikipedia.org/wiki/National_Public_Radio "National Public Radio"). Retrieved 2025-03-14. 31. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-31) Loudon I. "Deaths in childbed from the eighteenth century to 1935". Med History 1986; 30: 1–41 32. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-32) Caplan CE (1995). ["The Childbed Fever Mystery and the Meaning of Medical Journalism"](https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html). McGill Journal of Medicine. 1 (1). Archived from [the original](http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html) on 2012-07-07. 33. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Ignaz_Semmelweis_33-0) Wyklicky H, Skopec M (1983). "Ignaz Philipp Semmelweis, the prophet of bacteriology". Infect Control. 4 (5): 367–370\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1017/S0195941700059762](https://doi.org/10.1017%2FS0195941700059762). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [6354955](https://pubmed.ncbi.nlm.nih.gov/6354955). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [25830725](https://api.semanticscholar.org/CorpusID:25830725). 34. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-childbed_fever_34-0) De Costa CM (Nov 2002). [""The contagiousness of childbed fever": a short history of puerperal sepsis and its treatment"](http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html). The Medical Journal of Australia. 177 (11–12\): 668–671\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5694/j.1326-5377.2002.tb05004.x](https://doi.org/10.5694%2Fj.1326-5377.2002.tb05004.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12463995](https://pubmed.ncbi.nlm.nih.gov/12463995). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12164328](https://api.semanticscholar.org/CorpusID:12164328). [Archived](https://web.archive.org/web/20061203030203/http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html) from the original on 2006-12-03. 35. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-35) Gordon A (1795). [A Treatise on the Epidemic Puerperal Fever of Aberdeen](https://archive.org/details/treatiseonepidem00gord). London, England: G.G. and J. Robinson. pp. [63](https://archive.org/details/treatiseonepidem00gord/page/63)–64. On p. 63, Gordon recognized that puerperal fever was infectious: "But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted." From p. 64: "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women." 36. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Dr_Alexander_Gordon_36-0) ["Treatise on the Epidemic of Puerperal Fever"](https://web.archive.org/web/20080720005441/http://www.general-anaesthesia.com/images/ignaz-semmelweis.html). www.general-anaesthesia.com. Archived from [the original](https://www.general-anaesthesia.com/images/ignaz-semmelweis.html) on July 20, 2008. Retrieved September 15, 2011. 37. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-37) Watson (February 18, 1842). ["Lectures on the principles and practice of physic: Diseases of the abdomen"](https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=811). The London Medical Gazette. 29: 801–808\. [From p. 806](https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=816): "Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another." 38. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-38) [The Medical Journal of Australia."The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment"](http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html#i1067496) [Archived](https://web.archive.org/web/20061203030203/http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html) 2006-12-03 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 39. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-39) Holmes OW (1842–1843). ["On the contagiousness of puerperal fever"](https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=513). The New England Quarterly Journal of Medicine. 1: 503–530\. 40. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-bartleby.com_40-0) [Oliver Wendell Holmes: The Contagiousness of Puerperal Fever](http://www.bartleby.com/38/5/1.html) [Archived](https://web.archive.org/web/20070203165344/http://www.bartleby.com/38/5/1.html) 2007-02-03 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 41. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-41) (Holmes, 1842–1843), [p. 510.](https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=520) 42. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-42) Meigs CD (1854). [On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class](https://archive.org/details/onnaturesignstre1854meig). Philadelphia, Pennsylvania: Blanchard and Lea. p. [104](https://archive.org/details/onnaturesignstre1854meig/page/104). From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: "He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean." 43. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GordononMotherhood_43-0) [Gordon R](https://en.wikipedia.org/wiki/Richard_Gordon_\(English_author\) "Richard Gordon (English author)") (1983). "Disastrous Motherhood: Tales from the Vienna Wards". Great Medical Disasters. London: Hutchinson & Co. pp. 43–46 \[43\]. 44. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-44) Treves F (1923). "Ch. 2: The Old Receiving Room". [The Elephant Man and Other Reminiscences](https://archive.org/details/elephantmanother00trevuoft). London, England: Cassell and Company, Ltd. pp. [56](https://archive.org/details/elephantmanother00trevuoft/page/56)–57. 45. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GordononMotherhood44_45-0) Gordon, Richard (1983) p. 44 46. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-raju_46-0) Raju TN (1999). "Ignác Semmelweis and the etiology of fetal and neonatal sepsis". Journal of Perinatology. 19 (4): 307–310\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/sj.jp.7200155](https://doi.org/10.1038%2Fsj.jp.7200155). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10685244](https://pubmed.ncbi.nlm.nih.gov/10685244). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [29047987](https://api.semanticscholar.org/CorpusID:29047987). 47. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-colyer_47-0) Christa Colyer.["Childbed fever: a nineteenth-century mystery,"](http://www.sciencecases.org/childbed_fever/childbed_fever.asp) [Archived](https://web.archive.org/web/20090416054052/http://www.sciencecases.org/childbed_fever/childbed_fever.asp) 2009-04-16 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003). 48. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-48) Colebrook, L; Kenny, M (June 6, 1936). "Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil".Lancet 227(1): 1279–1286. 49. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-49) Sue Bale, Vanessa Jones (2006). [Wound care nursing](https://books.google.com/books?id=zbIuXxpoRXMC&q=fireguards+act+1952&pg=PA54). Elsevier Health Sciences. p. 54. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7234-3344-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7234-3344-6 "Special:BookSources/978-0-7234-3344-6") . Retrieved 2009-08-05. 50. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-50) Sophie Campbell (2012-08-14). ["Sudeley Castle: the curious life and death of Katherine Parr"](https://www.telegraph.co.uk/travel/destinations/europe/united-kingdom/england/cotswolds/articles/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr/). The Telegraph. Retrieved 2025-03-14. 51. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-51) Quoted from [Will Durant](https://en.wikipedia.org/wiki/Will_Durant "Will Durant")'s "The Age of Rousseau".\[[full citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citing_sources#What_information_to_include "Wikipedia:Citing sources")\] 52. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-52) Beetham M (2004). ["Beeton, Samuel Orchart (1831–1877)"](http://www.oxforddnb.com/view/article/45481). [Oxford Dictionary of National Biography](https://en.wikipedia.org/wiki/Dictionary_of_National_Biography#Oxford_Dictionary_of_National_Biography "Dictionary of National Biography") (online ed.). Oxford University Press. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/ref:odnb/45481](https://doi.org/10.1093%2Fref%3Aodnb%2F45481). Retrieved 23 November 2015. `{{cite encyclopedia}}`: CS1 maint: ref duplicates default ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_ref_duplicates_default "Category:CS1 maint: ref duplicates default")) (Subscription, [Wikipedia Library](https://wikipedialibrary.wmflabs.org/partners/88/) access or [UK public library membership](https://www.oxforddnb.com/help/subscribe#public) required.) 53. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-53) [Hughes K](https://en.wikipedia.org/wiki/Kathryn_Hughes "Kathryn Hughes") (2006). [The Short Life and Long Times of Mrs Beeton](https://books.google.com/books?id=p5NvuLMB3tYC&pg=PP1). London: HarperCollins Publishers. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7524-6122-9](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7524-6122-9 "Special:BookSources/978-0-7524-6122-9") . ## Further reading \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=14 "Edit section: Further reading")\] - Chaim W, Burstein E (August 2003). "Postpartum infection treatments: a review". Expert Opinion on Pharmacotherapy (review). 4 (8): 1297–313\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1517/14656566.4.8.1297](https://doi.org/10.1517%2F14656566.4.8.1297). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12877638](https://pubmed.ncbi.nlm.nih.gov/12877638). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [26781321](https://api.semanticscholar.org/CorpusID:26781321). - French L (August 2003). "Prevention and treatment of postpartum endometritis". Current Women's Health Reports (review). 3 (4): 274–9\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12844449](https://pubmed.ncbi.nlm.nih.gov/12844449). - Calhoun BC, Brost B (June 1995). "Emergency management of sudden puerperal fever". Obstetrics and Gynecology Clinics of North America (review). 22 (2): 357–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0889-8545(21)00185-6](https://doi.org/10.1016%2FS0889-8545%2821%2900185-6). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [7651676](https://pubmed.ncbi.nlm.nih.gov/7651676). ## External links \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=15 "Edit section: External links")\] \| \| \| \|---\|---\| \| Classification \| [D](https://www.wikidata.org/wiki/Q1419347 "d:Q1419347") [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10"): [O85](https://icd.who.int/browse10/2019/en#/O85) [ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes"): [672](http://www.icd9data.com/getICD9Code.ashx?icd9=672) [MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings"): [D011645](https://meshb.nlm.nih.gov/record/ui?ui=D011645) \| \| External resources \| [eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine"): [article/796892](https://emedicine.medscape.com/article/796892-overview) \| \| [v](https://en.wikipedia.org/wiki/Template:Pathology_of_pregnancy,_childbirth,_and_the_puerperium "Template:Pathology of pregnancy, childbirth, and the puerperium") [t](https://en.wikipedia.org/wiki/Template_talk:Pathology_of_pregnancy,_childbirth,_and_the_puerperium "Template talk:Pathology of pregnancy, childbirth, and the puerperium") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Pathology_of_pregnancy,_childbirth,_and_the_puerperium "Special:EditPage/Template:Pathology of pregnancy, childbirth, and the puerperium")Pathology of [pregnancy](https://en.wikipedia.org/wiki/Pregnancy "Pregnancy"), [childbirth](https://en.wikipedia.org/wiki/Childbirth "Childbirth"), and the [puerperium](https://en.wikipedia.org/wiki/Postpartum_period "Postpartum period") \| \| \|---\|---\| \| [Pregnancy](https://en.wikipedia.org/wiki/Complications_of_pregnancy "Complications of pregnancy") \| \| \| \| \| \| [Pregnancy with abortive outcome](https://en.wikipedia.org/wiki/Pregnancy_with_abortive_outcome "Pregnancy with abortive outcome") \| [Abortion](https://en.wikipedia.org/wiki/Abortion "Abortion") [Ectopic pregnancy](https://en.wikipedia.org/wiki/Ectopic_pregnancy "Ectopic pregnancy") [Abdominal](https://en.wikipedia.org/wiki/Abdominal_pregnancy "Abdominal pregnancy") [Cervical](https://en.wikipedia.org/wiki/Cervical_pregnancy "Cervical pregnancy") [Heterotopic](https://en.wikipedia.org/wiki/Heterotopic_pregnancy "Heterotopic pregnancy") [Interstitial](https://en.wikipedia.org/wiki/Interstitial_pregnancy "Interstitial pregnancy") [Ovarian](https://en.wikipedia.org/wiki/Ovarian_pregnancy "Ovarian pregnancy") [Rudimentary horn](https://en.wikipedia.org/wiki/Rudimentary_horn_pregnancy "Rudimentary horn pregnancy") [Embryo loss](https://en.wikipedia.org/wiki/Embryo_loss "Embryo loss") [Fetal resorption](https://en.wikipedia.org/wiki/Fetal_resorption "Fetal resorption") [Molar pregnancy](https://en.wikipedia.org/wiki/Molar_pregnancy "Molar pregnancy") [Miscarriage](https://en.wikipedia.org/wiki/Miscarriage "Miscarriage") [Stillbirth](https://en.wikipedia.org/wiki/Stillbirth "Stillbirth") \| \| [Edema](https://en.wikipedia.org/wiki/Edema "Edema"), [proteinuria](https://en.wikipedia.org/wiki/Proteinuria "Proteinuria"), and [hypertensive disorders](https://en.wikipedia.org/wiki/Hypertensive_disease_of_pregnancy "Hypertensive disease of pregnancy") \| [Gestational hypertension](https://en.wikipedia.org/wiki/Gestational_hypertension "Gestational hypertension") [Pre-eclampsia](https://en.wikipedia.org/wiki/Pre-eclampsia "Pre-eclampsia") [HELLP syndrome](https://en.wikipedia.org/wiki/HELLP_syndrome "HELLP syndrome") [Eclampsia](https://en.wikipedia.org/wiki/Eclampsia "Eclampsia") \| \| Other, predominantly related to pregnancy \| \| \| \| \| \| [Digestive system](https://en.wikipedia.org/wiki/Human_digestive_system "Human digestive system") \| [Acute fatty liver of pregnancy](https://en.wikipedia.org/wiki/Acute_fatty_liver_of_pregnancy "Acute fatty liver of pregnancy") [Gestational diabetes](https://en.wikipedia.org/wiki/Gestational_diabetes "Gestational diabetes") [Hepatitis E](https://en.wikipedia.org/wiki/Hepatitis_E "Hepatitis E") [Hyperemesis gravidarum](https://en.wikipedia.org/wiki/Hyperemesis_gravidarum "Hyperemesis gravidarum") [Intrahepatic cholestasis of pregnancy](https://en.wikipedia.org/wiki/Intrahepatic_cholestasis_of_pregnancy "Intrahepatic cholestasis of pregnancy") \| \| [Integumentary system](https://en.wikipedia.org/wiki/Integumentary_system "Integumentary system") / [dermatoses of pregnancy](https://en.wikipedia.org/wiki/Dermatoses_of_pregnancy "Dermatoses of pregnancy") \| [Gestational pemphigoid](https://en.wikipedia.org/wiki/Gestational_pemphigoid "Gestational pemphigoid") [Impetigo herpetiformis](https://en.wikipedia.org/wiki/Impetigo_herpetiformis "Impetigo herpetiformis") [Intrahepatic cholestasis of pregnancy](https://en.wikipedia.org/wiki/Intrahepatic_cholestasis_of_pregnancy "Intrahepatic cholestasis of pregnancy") [Linea nigra](https://en.wikipedia.org/wiki/Linea_nigra "Linea nigra") [Prurigo gestationis](https://en.wikipedia.org/wiki/Prurigo_gestationis "Prurigo gestationis") [Pruritic folliculitis of pregnancy](https://en.wikipedia.org/wiki/Pruritic_folliculitis_of_pregnancy "Pruritic folliculitis of pregnancy") [Pruritic urticarial papules and plaques of pregnancy (PUPPP)](https://en.wikipedia.org/wiki/Pruritic_urticarial_papules_and_plaques_of_pregnancy "Pruritic urticarial papules and plaques of pregnancy") [Stretch marks](https://en.wikipedia.org/wiki/Stretch_marks "Stretch marks") \| \| [Nervous system](https://en.wikipedia.org/wiki/Nervous_system "Nervous system") \| [Chorea gravidarum](https://en.wikipedia.org/wiki/Chorea_gravidarum "Chorea gravidarum") \| \| [Blood](https://en.wikipedia.org/wiki/Blood "Blood") \| [Gestational thrombocytopenia](https://en.wikipedia.org/wiki/Gestational_thrombocytopenia "Gestational thrombocytopenia") [Pregnancy-induced hypercoagulability](https://en.wikipedia.org/wiki/Hypercoagulability_in_pregnancy "Hypercoagulability in pregnancy") \| \| Maternal care related to the [fetus](https://en.wikipedia.org/wiki/Fetus "Fetus") and [amniotic cavity](https://en.wikipedia.org/wiki/Amniotic_cavity "Amniotic cavity") \| [amniotic fluid](https://en.wikipedia.org/wiki/Amniotic_fluid "Amniotic fluid") [Oligohydramnios](https://en.wikipedia.org/wiki/Oligohydramnios "Oligohydramnios") [Polyhydramnios](https://en.wikipedia.org/wiki/Polyhydramnios "Polyhydramnios") [Braxton Hicks contractions](https://en.wikipedia.org/wiki/Braxton_Hicks_contractions "Braxton Hicks contractions") [chorion](https://en.wikipedia.org/wiki/Chorion "Chorion") / [amnion](https://en.wikipedia.org/wiki/Amnion "Amnion") [Chorioamnionitis](https://en.wikipedia.org/wiki/Chorioamnionitis "Chorioamnionitis") [Chorionic hematoma](https://en.wikipedia.org/wiki/Chorionic_hematoma "Chorionic hematoma") [Constriction ring syndrome](https://en.wikipedia.org/wiki/Constriction_ring_syndrome "Constriction ring syndrome") [Monoamniotic twins](https://en.wikipedia.org/wiki/Monoamniotic_twins "Monoamniotic twins") [Prelabor rupture of membranes](https://en.wikipedia.org/wiki/Prelabor_rupture_of_membranes "Prelabor rupture of membranes") [Obstetrical bleeding](https://en.wikipedia.org/wiki/Obstetrical_bleeding "Obstetrical bleeding") [Antepartum](https://en.wikipedia.org/wiki/Antepartum_bleeding "Antepartum bleeding") [placenta](https://en.wikipedia.org/wiki/Placental_disease "Placental disease") [Circumvallate placenta](https://en.wikipedia.org/wiki/Circumvallate_placenta "Circumvallate placenta") [Monochorionic twins](https://en.wikipedia.org/wiki/Monochorionic_twins "Monochorionic twins") [Placenta accreta](https://en.wikipedia.org/wiki/Placenta_accreta_spectrum "Placenta accreta spectrum") [Placenta praevia](https://en.wikipedia.org/wiki/Placenta_praevia "Placenta praevia") [Placental abruption](https://en.wikipedia.org/wiki/Placental_abruption "Placental abruption") [Twin-to-twin transfusion syndrome](https://en.wikipedia.org/wiki/Twin-to-twin_transfusion_syndrome "Twin-to-twin transfusion syndrome") \| \| [Labor](https://en.wikipedia.org/wiki/Obstetric_labor_complication "Obstetric labor complication") \| [Amniotic fluid embolism](https://en.wikipedia.org/wiki/Amniotic_fluid_embolism "Amniotic fluid embolism") [Cephalopelvic disproportion](https://en.wikipedia.org/wiki/Cephalopelvic_disproportion "Cephalopelvic disproportion") [Obstructed labour](https://en.wikipedia.org/wiki/Obstructed_labour "Obstructed labour") [Shoulder dystocia](https://en.wikipedia.org/wiki/Shoulder_dystocia "Shoulder dystocia") [Fetal distress](https://en.wikipedia.org/wiki/Fetal_distress "Fetal distress") [Locked twins](https://en.wikipedia.org/wiki/Locked_twins "Locked twins") [Nuchal cord](https://en.wikipedia.org/wiki/Nuchal_cord "Nuchal cord") [Obstetrical bleeding](https://en.wikipedia.org/wiki/Obstetrical_bleeding "Obstetrical bleeding") [Postpartum](https://en.wikipedia.org/wiki/Postpartum_bleeding "Postpartum bleeding") [Pain management during childbirth](https://en.wikipedia.org/wiki/Pain_management_during_childbirth "Pain management during childbirth") [placenta](https://en.wikipedia.org/wiki/Placental_disease "Placental disease") [Placenta accreta](https://en.wikipedia.org/wiki/Placenta_accreta_spectrum "Placenta accreta spectrum") [Preterm birth](https://en.wikipedia.org/wiki/Preterm_birth "Preterm birth") [Postmature birth](https://en.wikipedia.org/wiki/Postterm_pregnancy "Postterm pregnancy") [Umbilical cord prolapse](https://en.wikipedia.org/wiki/Umbilical_cord_prolapse "Umbilical cord prolapse") [Uterine inversion](https://en.wikipedia.org/wiki/Uterine_inversion "Uterine inversion") [Uterine rupture](https://en.wikipedia.org/wiki/Uterine_rupture "Uterine rupture") [Vasa praevia](https://en.wikipedia.org/wiki/Vasa_praevia "Vasa praevia") [Uterine atony](https://en.wikipedia.org/wiki/Uterine_atony "Uterine atony") \| \| [Puerperal](https://en.wikipedia.org/wiki/Puerperal_disorder "Puerperal disorder") \| [Breastfeeding difficulties](https://en.wikipedia.org/wiki/Breastfeeding_difficulties "Breastfeeding difficulties") [Low milk supply](https://en.wikipedia.org/wiki/Low_milk_supply "Low milk supply") [Cracked nipples](https://en.wikipedia.org/wiki/Cracked_nipple "Cracked nipple") [Breast engorgement](https://en.wikipedia.org/wiki/Breast_engorgement "Breast engorgement") [Childbirth-related post-traumatic stress disorder](https://en.wikipedia.org/wiki/Childbirth-related_post-traumatic_stress_disorder "Childbirth-related post-traumatic stress disorder") [Pubic symphysis diastasis](https://en.wikipedia.org/wiki/Pubic_symphysis_diastasis "Pubic symphysis diastasis") [Postpartum bleeding](https://en.wikipedia.org/wiki/Postpartum_bleeding "Postpartum bleeding") [Peripartum cardiomyopathy](https://en.wikipedia.org/wiki/Peripartum_cardiomyopathy "Peripartum cardiomyopathy") [Postpartum depression](https://en.wikipedia.org/wiki/Postpartum_depression "Postpartum depression") [Postpartum infections]() [Postpartum psychosis](https://en.wikipedia.org/wiki/Postpartum_psychosis "Postpartum psychosis") [Postpartum thyroiditis](https://en.wikipedia.org/wiki/Postpartum_thyroiditis "Postpartum thyroiditis") [Puerperal mastitis](https://en.wikipedia.org/wiki/Puerperal_mastitis "Puerperal mastitis") \| \| Other \| [Concomitant 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Readable Markdown	\| Postpartum infections \| \| \|---\|---\| \| Other names \| Puerperal fever, childbed fever, maternal sepsis, maternal infection, puerperal infections \| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/e/e4/Streptococcus_pyogenes.jpg/250px-Streptococcus_pyogenes.jpg)](https://en.wikipedia.org/wiki/File:Streptococcus_pyogenes.jpg) \| \| \| [Streptococcus pyogenes](https://en.wikipedia.org/wiki/Streptococcus_pyogenes "Streptococcus pyogenes") (red-stained spheres) is responsible for many cases of severe puerperal fever. \| \| \| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") \| [Obstetrics](https://en.wikipedia.org/wiki/Obstetrics "Obstetrics") \| \| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") \| Fever, lower abdominal pain, bad-smelling vaginal discharge[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") \| Typically multiple types of bacteria[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") \| [Caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section"), [premature rupture of membranes](https://en.wikipedia.org/wiki/Premature_rupture_of_membranes "Premature rupture of membranes"), [prolonged labour](https://en.wikipedia.org/wiki/Prolonged_labour "Prolonged labour"), [malnutrition](https://en.wikipedia.org/wiki/Malnutrition "Malnutrition"), [diabetes](https://en.wikipedia.org/wiki/Diabetes "Diabetes")[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) \| \| Treatment \| [Antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics")[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) \| \| Frequency \| 11\.8 million[\[3\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015Pre-3) \| \| Deaths \| 17,900[\[4\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015De-4) \| Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial [infections](https://en.wikipedia.org/wiki/Infection "Infection") of the [female reproductive tract](https://en.wikipedia.org/wiki/Female_reproductive_tract "Female reproductive tract") following [childbirth](https://en.wikipedia.org/wiki/Childbirth "Childbirth") or [miscarriage](https://en.wikipedia.org/wiki/Miscarriage "Miscarriage").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Signs and symptoms usually include a [fever](https://en.wikipedia.org/wiki/Fever "Fever") greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly odorous [vaginal discharge](https://en.wikipedia.org/wiki/Vaginal_discharge "Vaginal discharge").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\[5\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hir2014-5) The most common infection is that of the [uterus](https://en.wikipedia.org/wiki/Uterus "Uterus") and surrounding tissues known as puerperal sepsis, postpartum metritis, or postpartum endometritis.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[6\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hac2015-6) Risk factors include [caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section") (C-section), the presence of certain bacteria such as [group B streptococcus](https://en.wikipedia.org/wiki/Group_B_streptococcus "Group B streptococcus") in the vagina, [premature rupture of membranes](https://en.wikipedia.org/wiki/Premature_rupture_of_membranes "Premature rupture of membranes"), multiple [vaginal exams](https://en.wikipedia.org/wiki/Vaginal_exam "Vaginal exam"), manual removal of the [placenta](https://en.wikipedia.org/wiki/Placenta "Placenta"), and [prolonged labour](https://en.wikipedia.org/wiki/Prolonged_labour "Prolonged labour") among others.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) Most infections involve a number of types of bacteria.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Diagnosis is rarely helped by [culturing](https://en.wikipedia.org/wiki/Microbiological_culture "Microbiological culture") of the vagina or blood.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those who do not improve, [medical imaging](https://en.wikipedia.org/wiki/Medical_imaging "Medical imaging") may be required.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Other causes of fever following delivery include [breast engorgement](https://en.wikipedia.org/wiki/Breast_engorgement "Breast engorgement"), [urinary tract infections](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"), infections of an abdominal incision or an [episiotomy](https://en.wikipedia.org/wiki/Episiotomy "Episiotomy"), and [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1)[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) Due to the risks following caesarean section, it is recommended that all women receive a preventive dose of [antibiotics](https://en.wikipedia.org/wiki/Antibiotic "Antibiotic") such as [ampicillin](https://en.wikipedia.org/wiki/Ampicillin "Ampicillin") around the time of surgery.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Treatment of established infections is with antibiotics, with most people improving in two to three days.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those with mild disease, oral antibiotics may be used; otherwise, [intravenous](https://en.wikipedia.org/wiki/Intravenous "Intravenous") antibiotics are recommended.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Common antibiotics include a combination of ampicillin and [gentamicin](https://en.wikipedia.org/wiki/Gentamicin "Gentamicin") following vaginal delivery or [clindamycin](https://en.wikipedia.org/wiki/Clindamycin "Clindamycin") and gentamicin in those who have had a C-section.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In those who are not improving with appropriate treatment, other complications such as an [abscess](https://en.wikipedia.org/wiki/Abscess "Abscess") should be considered.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In 2015, about 11.8 million maternal infections occurred.[\[3\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015Pre-3) In the developed world about 1% to 2% develop uterine infections following [vaginal delivery](https://en.wikipedia.org/wiki/Vaginal_delivery "Vaginal delivery").[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) This increases to 5% to 13% among those who have more difficult deliveries and 50% with C-sections before the use of preventive antibiotics.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In 2015, these infections resulted in 17,900 deaths down from 34,000 deaths in 1990.[\[4\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GBD2015De-4)[\[7\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GDB2013-7) They are the cause of about 10% of deaths around the time of pregnancy.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) The first known descriptions of the condition date back to at least the 5th century BCE in the writings of [Hippocrates](https://en.wikipedia.org/wiki/Hippocrates "Hippocrates").[\[8\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-8) These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced.[\[9\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-9) In 1847, Hungarian physician [Ignaz Semmelweiss](https://en.wikipedia.org/wiki/Ignaz_Semmelweiss "Ignaz Semmelweiss") decreased death from the disease in the First Obstetrical Clinic of Vienna from nearly 20% to 2% through the use of [handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing") with [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite").[\[10\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-10)[\[11\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-11) Signs and symptoms usually include a [fever](https://en.wikipedia.org/wiki/Fever "Fever") greater than 38.0 °C (100.4 °F), chills, low abdominal pain, and possibly bad-smelling vaginal discharge.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) It usually occurs after the first 24 hours and within the first ten days following delivery.[\[5\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Hir2014-5) After childbirth, the [female genital tract](https://en.wikipedia.org/wiki/Female_reproductive_system "Female reproductive system") has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of the [uterus](https://en.wikipedia.org/wiki/Uterus "Uterus"), or it may spread beyond to cause [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis") or other illnesses, especially when resistance has been lowered by long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the [placenta](https://en.wikipedia.org/wiki/Placenta "Placenta") (afterbirth), but [pathogenic](https://en.wikipedia.org/wiki/Pathogenic "Pathogenic") organisms may also affect [lacerations](https://en.wikipedia.org/wiki/Lacerations "Lacerations") of any part of the genital tract. By whatever portal, they can invade the [bloodstream](https://en.wikipedia.org/wiki/Bloodstream "Bloodstream") and [lymph system](https://en.wikipedia.org/wiki/Lymph_system "Lymph system") to cause [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis"), [cellulitis](https://en.wikipedia.org/wiki/Cellulitis "Cellulitis") (inflammation of connective tissue), and pelvic or generalized [peritonitis](https://en.wikipedia.org/wiki/Peritonitis "Peritonitis") (inflammation of the abdominal lining). The severity of the illness depends on the [virulence](https://en.wikipedia.org/wiki/Virulence "Virulence") of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are [Streptococcus pyogenes](https://en.wikipedia.org/wiki/Streptococcus_pyogenes "Streptococcus pyogenes"); [staphylococci](https://en.wikipedia.org/wiki/Staphylococci "Staphylococci") (inhabitants of the skin and of [pimples](https://en.wikipedia.org/wiki/Pimples "Pimples"), [carbuncles](https://en.wikipedia.org/wiki/Carbuncles "Carbuncles"), and many other [pustular](https://en.wikipedia.org/wiki/Pustular "Pustular") eruptions); the [anaerobic streptococci](https://en.wikipedia.org/wiki/Peptostreptococcus "Peptostreptococcus"), which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; [Escherichia coli](https://en.wikipedia.org/wiki/Escherichia_coli "Escherichia coli")[\[12\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-12) and [Clostridium perfringens](https://en.wikipedia.org/wiki/Clostridium_perfringens "Clostridium perfringens") (inhabitants of the lower bowel); and [Clostridium tetani](https://en.wikipedia.org/wiki/Clostridium_tetani "Clostridium tetani").[\[13\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-13) Causes (listed in order of decreasing frequency) include: [endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis"), [urinary tract infection](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"), [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia")/[atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"), [wound infection](https://en.wikipedia.org/wiki/Wound_infection "Wound infection"), and [septic pelvic thrombophlebitis](https://en.wikipedia.org/wiki/Septic_pelvic_thrombophlebitis "Septic pelvic thrombophlebitis"). Sepsis risk factors for each condition are listed in order of the [postpartum](https://en.wikipedia.org/wiki/Postpartum "Postpartum") day (PPD) on which the condition generally occurs.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] - PPD 0: [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis") risk factors include [general anesthesia](https://en.wikipedia.org/wiki/General_anesthesia "General anesthesia"), [cigarette smoking](https://en.wikipedia.org/wiki/Cigarette_smoking "Cigarette smoking"), and [obstructive lung disease](https://en.wikipedia.org/wiki/Obstructive_lung_disease "Obstructive lung disease"). - PPD 1–2: urinary tract infection risk factors include multiple [catheterization](https://en.wikipedia.org/wiki/Catheterization "Catheterization") during labor, multiple [vaginal examinations](https://en.wikipedia.org/wiki/Vaginal_examination "Vaginal examination") during labor, and untreated [bacteriuria](https://en.wikipedia.org/wiki/Bacteriuria "Bacteriuria"). - PPD 2–3: endometritis ( the most common cause ) risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and multiple vaginal examinations during labor. - PPD 4–5: wound infection risk factors include emergency [cesarean section](https://en.wikipedia.org/wiki/Cesarean_section "Cesarean section"), prolonged [membrane rupture](https://en.wikipedia.org/wiki/Membrane_rupture "Membrane rupture"), prolonged labor, and multiple vaginal examinations during labor. - PPD 5–6: septic pelvic thrombophlebitis risk factors include emergency cesarean section, prolonged membrane rupture, prolonged labor, and diffuse difficult vaginal childbirth. - PPD 7–21: [mastitis](https://en.wikipedia.org/wiki/Mastitis "Mastitis") risk factors include nipple trauma from [breastfeeding](https://en.wikipedia.org/wiki/Breastfeeding "Breastfeeding"). Puerperal fever is diagnosed with: - A temperature rise above 38 °C (100.4 °F) maintained over 24 hours or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. (ICD-10) - Oral temperature of 38 °C (100.4 °F) or more on any two of the first ten days postpartum. (USJCMW)[\[14\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-gfmer.ch-14) Puerperal fever (from the Latin puer, male child (boy)), is no longer favored as a diagnostic category. Instead, contemporary terminology specifies:[\[15\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-15) 1. the specific target of infection: [endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis") (inflammation of the inner lining of the uterus), [metrophlebitis](https://en.wikipedia.org/w/index.php?title=Metrophlebitis&action=edit&redlink=1 "Metrophlebitis (page does not exist)") (inflammation of the veins of the uterus), and [peritonitis](https://en.wikipedia.org/wiki/Peritonitis "Peritonitis") (inflammation of the membrane lining of the abdomen). 2. the severity of the infection: less serious [infection](https://en.wikipedia.org/wiki/Infection "Infection") (contained multiplication of microbes) or possibly life-threatening [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis") (uncontrolled and uncontained multiplication of microbes throughout the bloodstream). [Endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis") is a polymicrobial infection. It frequently includes organisms such as [Ureaplasma](https://en.wikipedia.org/wiki/Ureaplasma "Ureaplasma"), [Streptococcus](https://en.wikipedia.org/wiki/Streptococcus "Streptococcus"), [Mycoplasma](https://en.wikipedia.org/wiki/Mycoplasma "Mycoplasma"), and [Bacteroides](https://en.wikipedia.org/wiki/Bacteroides "Bacteroides"), and may also include organisms such as [Gardnerella](https://en.wikipedia.org/wiki/Gardnerella "Gardnerella"), [Chlamydia](https://en.wikipedia.org/wiki/Chlamydia_\(bacterium\) "Chlamydia (bacterium)"), [Lactobacillus](https://en.wikipedia.org/wiki/Lactobacillus "Lactobacillus"), [Escherichia](https://en.wikipedia.org/wiki/Escherichia "Escherichia"), and [Staphylococcus](https://en.wikipedia.org/wiki/Staphylococcus "Staphylococcus").[\[16\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-16) ### Differential diagnosis \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=5 "Edit section: Differential diagnosis")\] Several other conditions can cause fevers following delivery, including: [urinary tract infections](https://en.wikipedia.org/wiki/Urinary_tract_infections "Urinary tract infections"), [breast engorgement](https://en.wikipedia.org/wiki/Breast_engorgement "Breast engorgement"), [atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"), and surgical incisions, among others.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) Antibiotics have been used to prevent and treat these infections; however, the misuse of antibiotics is a serious problem for global health.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) It is recommended that guidelines be followed that outline when it is appropriate to give antibiotics and which antibiotics are most effective.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2) [Atelectasis](https://en.wikipedia.org/wiki/Atelectasis "Atelectasis"): mild to moderate fever, no changes or mild rales on chest [auscultation](https://en.wikipedia.org/wiki/Auscultation "Auscultation").[\[17\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-17) Management: pulmonary exercises, ambulation (deep breathing and walking). [Urinary tract infection](https://en.wikipedia.org/wiki/Urinary_tract_infection "Urinary tract infection"): high fever, malaise, [costovertebral](https://en.wikipedia.org/wiki/Costovertebral_angle_tenderness "Costovertebral angle tenderness") tenderness, positive urine culture.[\[18\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-18) Management: antibiotics as per culture sensitivity (cephalosporin). [Endometritis](https://en.wikipedia.org/wiki/Endometritis "Endometritis"): moderate fever, exquisite uterine tenderness, minimal abdominal findings.[\[19\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-19) Management: multiple agent IV antibiotics to cover polymicrobial organisms: clindamycin, gentamicin, and addition of ampicillin if no response, no cultures are necessary. [Wound infection](https://en.wikipedia.org/wiki/Wound_infection "Wound infection"): persistent spiking fever despite antibiotics, wound [erythema](https://en.wikipedia.org/wiki/Erythema "Erythema") or fluctuance, wound drainage.[\[20\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-20) Management: antibiotics for cellulitis, open and drain wound, saline-soaked packing twice a day, secondary closure. [Septic pelvic thrombophlebitis](https://en.wikipedia.org/wiki/Septic_pelvic_thrombophlebitis "Septic pelvic thrombophlebitis"): persistent wide fever swings despite antibiotics, usually normal abdominal or pelvic exams.[\[21\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-21) Management: IV heparin for 7–10 days at rates sufficient to prolong the PTT to double the baseline values. [Mastitis](https://en.wikipedia.org/wiki/Mastitis "Mastitis"): unilateral, localized erythema, [edema](https://en.wikipedia.org/wiki/Edema "Edema"), tenderness.[\[22\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-22) Management: antibiotics for cellulitis, open and drain the abscess if present. The number of cases of puerperal sepsis per year shows wide variations among published literature—this may be related to different definitions, recordings etc.[\[14\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-gfmer.ch-14) Globally, bacterial infections are the cause of 10% of [maternal deaths](https://en.wikipedia.org/wiki/Maternal_death "Maternal death")—this is more common in low income countries but is also a direct cause of maternal deaths in high-income countries.[\[2\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-WHOBook2015-2)[\[23\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-23) In the United States, puerperal infections are believed to occur in between 1% and 8% of all births. About three die from puerperal sepsis for every 100,000 births. The single most important risk factor is [caesarean section](https://en.wikipedia.org/wiki/Caesarean_section "Caesarean section").[\[24\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-24) The number of maternal deaths in the United States is about 13 in 100,000. They make up about 11% of pregnancy-related deaths in the United States.[\[1\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-W2014-1) In the United Kingdom from 1985 to 2005, the number of direct deaths associated with genital tract sepsis per 100,000 pregnancies was 0.40–0.85.[\[25\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-25) In 2003–2005, genital tract sepsis accounted for 14% of direct causes of maternal death.[\[26\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-26) Puerperal infections in the 18th and 19th centuries affected, on average, 6 to 9 women in every 1,000 births, killing two to three of them with peritonitis or sepsis. It was the single most common cause of maternal mortality, accounting for about half of all deaths related to [childbirth](https://en.wikipedia.org/wiki/Childbirth "Childbirth"), and was second only to [tuberculosis](https://en.wikipedia.org/wiki/Tuberculosis "Tuberculosis") in killing women of childbearing age. A rough estimate is that about 250,000–500,000 died from puerperal fever in the 18th and 19th centuries in England and Wales alone.[\[27\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-27) Although it had been recognized from as early as the time of the [Hippocratic corpus](https://en.wikipedia.org/wiki/Hippocratic_corpus "Hippocratic corpus") that women in childbed were prone to fevers, the distinct name "puerperal fever" appears in historical records only from the early 18th century.[\[28\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-28) The death rate for women giving birth decreased in the 20th century in [developed countries](https://en.wikipedia.org/wiki/Developed_countries "Developed countries"). The decline may be partly attributed to improved environmental conditions, better [obstetrical](https://en.wikipedia.org/wiki/Obstetrical "Obstetrical") care, and the use of [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics"). Another reason appears to be a lessening of the virulence or invasiveness of Streptococcus pyogenes. That organism is also the cause of [scarlet fever](https://en.wikipedia.org/wiki/Scarlet_fever "Scarlet fever"), which declined over the same period but has seen a rise in the last decade worldwide, especially in Asia, with smaller outbreaks in the US and Canada. The UK reported 12,906 cases between September 2015 and April 2016, which is the largest outbreak since 1969.[\[29\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-29) ### "The Doctor's Plague" \[[edit](https://en.wikipedia.org/w/index.php?title=Postpartum_infections&action=edit&section=9 "Edit section: \"The Doctor's Plague\"")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Yearly_mortality_rates_1784-1849.png/330px-Yearly_mortality_rates_1784-1849.png)](https://en.wikipedia.org/wiki/File:Yearly_mortality_rates_1784-1849.png) In his 1861 book, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") presented evidence to demonstrate that the advent of [pathological anatomy](https://en.wikipedia.org/wiki/Pathological_anatomy "Pathological anatomy") in Vienna in 1823 (vertical line) was correlated to the incidence of fatal childbed fever there. Onset of [chlorine](https://en.wikipedia.org/wiki/Chlorine "Chlorine") handwash in 1847 marked by vertical line. Rates for the Dublin maternity hospital, which had no pathological anatomy, are shown for comparison ([view rates](https://en.wikipedia.org/wiki/Historical_mortality_rates_of_puerperal_fever#Yearly_mortality_rates_for_birth_giving_women_1784-1849 "Historical mortality rates of puerperal fever")). His efforts were futile, however. From the 17th century through to the mid-to-late 19th century, the majority of childbed fever cases were caused by the doctors themselves. With no knowledge of [germs](https://en.wikipedia.org/wiki/Microorganism "Microorganism"), doctors did not believe hand washing was needed.[\[30\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-30) Hospitals for childbirth became common in the 17th century in many European cities. These "lying-in" hospitals were established at a time when there was no knowledge of [antisepsis](https://en.wikipedia.org/wiki/Antisepsis "Antisepsis") or [epidemiology](https://en.wikipedia.org/wiki/Epidemiology "Epidemiology"), and women were subjected to crowding, frequent vaginal examinations, and the use of contaminated instruments, dressings, and bedding. It was common for a doctor to deliver one baby after another, without washing his hands or changing clothes between patients.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] The first recorded epidemic of puerperal fever occurred at the [Hôtel-Dieu de Paris](https://en.wikipedia.org/wiki/H%C3%B4tel-Dieu_de_Paris "Hôtel-Dieu de Paris") in 1646. Hospitals throughout Europe and America consistently reported death rates between 20% and 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards.[\[31\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-31) In the early 19th century, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in a [maternity ward](https://en.wikipedia.org/wiki/Maternity_ward "Maternity ward"). His investigation discovered that washing hands before a delivery with a [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite") solution reduced childbed fever fatalities by 90%.[\[32\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-32) His findings were not well received by the medical profession, because they conflicted both with existing medical concepts, and with the image doctors had of themselves.[\[33\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Ignaz_Semmelweis-33) The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and, following a breakdown, eventually died in a mental asylum.[\[34\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-childbed_fever-34) Semmelweis was not the only doctor ignored after sounding a warning about the problem. In his Treatise on the Epidemic of Puerperal Fever (1795), ex-naval surgeon and [Aberdonian](https://en.wikipedia.org/wiki/Aberdeen "Aberdeen") obstetrician [Alexander Gordon](https://en.wikipedia.org/wiki/Alexander_Gordon_\(physician\) "Alexander Gordon (physician)") (1752–1799) warned that the disease was transmitted from one case to another by midwives and doctors. Gordon wrote, "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women."[\[35\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-35)[\[36\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-Dr_Alexander_Gordon-36) In 1842, [Thomas Watson](https://en.wikipedia.org/wiki/Sir_Thomas_Watson,_1st_Baronet "Sir Thomas Watson, 1st Baronet") (1792–1882), a professor of medicine at [King's College Hospital](https://en.wikipedia.org/wiki/King%27s_College_Hospital "King's College Hospital"), London, wrote: "Wherever puerperal fever is rife, or when a practitioner has attended any one instance of it, he should use most diligent [ablution](https://en.wikipedia.org/wiki/Hygiene "Hygiene")." Watson recommended [handwashing](https://en.wikipedia.org/wiki/Handwashing "Handwashing") with [chlorine](https://en.wikipedia.org/wiki/Chlorine "Chlorine") solution and changes of clothing for obstetric attendants "to prevent the practitioner becoming a vehicle of contagion and death between one patient and another."[\[37\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-37)[\[38\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-38) In 1843, [Oliver Wendell Holmes Sr.](https://en.wikipedia.org/wiki/Oliver_Wendell_Holmes_Sr. "Oliver Wendell Holmes Sr.") published The Contagiousness of Puerperal Fever and controversially concluded that puerperal fever was frequently carried from patient to patient by physicians and nurses. He suggested that clean clothing and avoidance of autopsies by those aiding birth would prevent the spread of the disease.[\[39\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-39)[\[40\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-bartleby.com-40) Holmes quoted Dr. James Blundell as stating, "... in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease."[\[41\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-41) Holmes' conclusions were ridiculed by many contemporaries, including [Charles Delucena Meigs](https://en.wikipedia.org/wiki/Charles_Delucena_Meigs "Charles Delucena Meigs"), a well-known obstetrician, who stated, "Doctors are gentlemen, and gentlemen's hands are clean."[\[42\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-42) Richard Gordon states that Holmes' exhortations "outraged obstetricians, particularly in Philadelphia".[\[43\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GordononMotherhood-43) In those days, "surgeons operated in blood-stiffened frock coats—the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "cleanliness was next to prudishness". He quotes [Sir Frederick Treves](https://en.wikipedia.org/wiki/Sir_Frederick_Treves,_1st_Baronet "Sir Frederick Treves, 1st Baronet") on that era: "There was no object in being clean. Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head."[\[44\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-44)[\[45\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-GordononMotherhood44-45) In 1844, [Ignaz Semmelweis](https://en.wikipedia.org/wiki/Ignaz_Semmelweis "Ignaz Semmelweis") was appointed assistant lecturer in the First Obstetric Division of the [Vienna General Hospital](https://en.wikipedia.org/wiki/Vienna_General_Hospital "Vienna General Hospital") (Allgemeines Krankenhaus), where medical students received their training. Working without knowledge of Holmes' essay, Semmelweis noticed his ward's 16% mortality rate from fever was substantially higher than the 2% mortality rate in the Second Division, where midwifery students were trained. Semmelweis also noticed that puerperal fever was rare in women who gave birth before arriving at the hospital. Semmelweis noted that doctors in the First Division performed autopsies each morning on women who had died the previous day, but the midwives were not required or allowed to perform such autopsies. He made the connection between autopsies and puerperal fever after a colleague, [Jakob Kolletschka](https://en.wikipedia.org/wiki/Jakob_Kolletschka "Jakob Kolletschka"), died of sepsis after a student accidentally cut his hand while performing an autopsy.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered all doctors and students working in the First Division to wash their hands in chlorinated lime solution before starting ward work and later ordered this before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.[\[46\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-raju-46) While his results were extraordinary, he was treated with skepticism and ridicule (see [Response to Semmelweis](https://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz_Semmelweis "Contemporary reaction to Ignaz Semmelweis")). He did the same work in St. Rochus hospital in [Pest, Hungary](https://en.wikipedia.org/wiki/Pest,_Hungary "Pest, Hungary"), and published his findings in 1860, but his discovery was again ignored.[\[47\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-colyer-47) In 1935, [Leonard Colebrook](https://en.wikipedia.org/wiki/Leonard_Colebrook "Leonard Colebrook") showed [Prontosil](https://en.wikipedia.org/wiki/Prontosil "Prontosil") was effective against [haemolytic](https://en.wikipedia.org/wiki/Haemolysis "Haemolysis") [streptococcus](https://en.wikipedia.org/wiki/Streptococcus "Streptococcus") and hence a cure for puerperal fever.[\[48\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-48)[\[49\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-49) Elite status was no protection against postpartum infections, as the deaths of several English queens attest. [Elizabeth of York](https://en.wikipedia.org/wiki/Elizabeth_of_York "Elizabeth of York"), queen consort of [Henry VII](https://en.wikipedia.org/wiki/Henry_VII_of_England "Henry VII of England"), died of puerperal fever one week after giving birth to a daughter, who also died. Her son [Henry VIII](https://en.wikipedia.org/wiki/Henry_VIII "Henry VIII") had two wives who died this way, [Jane Seymour](https://en.wikipedia.org/wiki/Jane_Seymour "Jane Seymour")\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] and [Catherine Parr](https://en.wikipedia.org/wiki/Catherine_Parr "Catherine Parr").[\[50\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-50) Suzanne Barnard, mother of philosopher [Jean-Jacques Rousseau](https://en.wikipedia.org/wiki/Jean-Jacques_Rousseau "Jean-Jacques Rousseau"), contracted childbed fever after giving birth to him and died nine days later. Her infant son was also in perilous health following the birth; the adult Rousseau later wrote that "I came into the world with so few signs of life that little hope was entertained of preserving me". He was nursed back to health by an aunt.[\[51\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-51) French natural philosopher [Émilie du Châtelet](https://en.wikipedia.org/wiki/%C3%89milie_du_Ch%C3%A2telet "Émilie du Châtelet") died in 1749. [Mary Wollstonecraft](https://en.wikipedia.org/wiki/Mary_Wollstonecraft "Mary Wollstonecraft"), author of [Vindication of the Rights of Woman](https://en.wikipedia.org/wiki/Vindication_of_the_Rights_of_Woman "Vindication of the Rights of Woman"), died ten days after giving birth to [her second daughter](https://en.wikipedia.org/wiki/Mary_Shelley "Mary Shelley"), who grew up to write [Frankenstein](https://en.wikipedia.org/wiki/Frankenstein "Frankenstein"). Other notables include African-American poet [Phillis Wheatley](https://en.wikipedia.org/wiki/Phillis_Wheatley "Phillis Wheatley") (1784), British housekeeping authority [Isabella Beeton](https://en.wikipedia.org/wiki/Isabella_Beeton "Isabella Beeton") (1865),[\[52\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-52)[\[53\]](https://en.wikipedia.org/wiki/Postpartum_infections#cite_note-53) and American author [Jean Webster](https://en.wikipedia.org/wiki/Jean_Webster "Jean Webster") in 1916 died of puerperal fever.\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\] In [Charles Dickens](https://en.wikipedia.org/wiki/Charles_Dickens "Charles Dickens")' novel [A Christmas Carol](https://en.wikipedia.org/wiki/A_Christmas_Carol "A Christmas Carol"), it is implied that both [Scrooge's](https://en.wikipedia.org/wiki/Ebenezer_Scrooge "Ebenezer Scrooge") mother and younger sister perished from this condition, explaining the character's animosity towards his nephew Fred and also his poor relationship with his own father\[[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")\]. - [Postpartum confinement](https://en.wikipedia.org/wiki/Postpartum_confinement "Postpartum confinement"), a traditional practice after childbirth 1. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-1) [c](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-2) [d](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-3) [e](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-4) [f](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-5) [g](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-6) [h](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-7) [i](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-8) [j](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-9) [k](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-10) [l](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-11) [m](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-12) [n](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-13) [o](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-14) [p](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-15) [q](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-16) [r](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-17) [s](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-18) [t](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-19) [u](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-20) [v](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-W2014_1-21) "37". Williams Obstetrics* (24th ed.). McGraw-Hill Professional. 2014. pp. Chapter 37. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-07-179893-8](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-179893-8 "Special:BookSources/978-0-07-179893-8") . 2. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-1) [c](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-2) [d](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-3) [e](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-4) [f](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-5) [g](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-WHOBook2015_2-6) [WHO recommendations for prevention and treatment of maternal peripartum infections](http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf) (PDF). World Health Organization. 2015. p. 1. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-92-4-154936-3](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-154936-3 "Special:BookSources/978-92-4-154936-3") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26598777](https://pubmed.ncbi.nlm.nih.gov/26598777). [Archived](https://web.archive.org/web/20160207091250/http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf) (PDF) from the original on 2016-02-07. 3. ^ [a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015Pre_3-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015Pre_3-1) GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (8 October 2016). ["Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). Lancet. 388* (10053): 1545–1602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)31678-6](https://doi.org/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5055577](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733282](https://pubmed.ncbi.nlm.nih.gov/27733282). 4. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015De_4-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GBD2015De_4-1) GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). ["Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903). Lancet. 388* (10053): 1459–1544\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/s0140-6736(16)31012-1](https://doi.org/10.1016%2Fs0140-6736%2816%2931012-1). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5388903](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733281](https://pubmed.ncbi.nlm.nih.gov/27733281). 5. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hir2014_5-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hir2014_5-1) Hiralal Konar (2014). [DC Dutta's Textbook of Obstetrics](https://books.google.com/books?id=LU2VAwAAQBAJ&pg=PA432). JP Medical Ltd. p. 432. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-93-5152-067-2](https://en.wikipedia.org/wiki/Special:BookSources/978-93-5152-067-2 "Special:BookSources/978-93-5152-067-2") . [Archived](https://web.archive.org/web/20151208041911/https://books.google.ca/books?id=LU2VAwAAQBAJ&pg=PA432) from the original on 2015-12-08. 6. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Hac2015_6-0)* "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-7558-3](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-7558-3 "Special:BookSources/978-1-4557-7558-3") . 7. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GDB2013_7-0) GBD 2013 Mortality and Causes of Death Collaborators (17 December 2014). ["Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604). Lancet. 385 (9963): 117–171\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(14)61682-2](https://doi.org/10.1016%2FS0140-6736%2814%2961682-2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4340604](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25530442](https://pubmed.ncbi.nlm.nih.gov/25530442). 8. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-8) Walvekar V (2005). [Manual of perinatal infections](https://books.google.com/books?id=DIOmY2ROeVAC&pg=PA152). New Delhi: Jaypee Bros. p. 153. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-81-8061-472-9](https://en.wikipedia.org/wiki/Special:BookSources/978-81-8061-472-9 "Special:BookSources/978-81-8061-472-9") . [Archived](https://web.archive.org/web/20160304220030/https://books.google.ca/books?id=DIOmY2ROeVAC&pg=PA152) from the original on 2016-03-04. 9. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-9) Magner LN (1992). [A history of medicine](https://archive.org/details/historyofmedicin0000magn). New York: Dekker. pp. [257](https://archive.org/details/historyofmedicin0000magn/page/257)–258. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-8247-8673-1](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8247-8673-1 "Special:BookSources/978-0-8247-8673-1") . 10. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-10) Anderson BL (April 2014). "Puerperal group A streptococcal infection: beyond Semmelweis". Obstetrics and Gynecology. 123 (4): 874–882\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/aog.0000000000000175](https://doi.org/10.1097%2Faog.0000000000000175). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24785617](https://pubmed.ncbi.nlm.nih.gov/24785617). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [24685091](https://api.semanticscholar.org/CorpusID:24685091). 11. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-11) Ataman AD, Vatanoğlu-Lutz EE, Yıldırım G (2013). ["Medicine in stamps-Ignaz Semmelweis and Puerperal Fever"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728). Journal of the Turkish German Gynecological Association. 14 (1): 35–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5152/jtgga.2013.08](https://doi.org/10.5152%2Fjtgga.2013.08). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3881728](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881728). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24592068](https://pubmed.ncbi.nlm.nih.gov/24592068). 12. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-12) Andy W Wong (2024-03-27). ["Postpartum Infections"](https://emedicine.medscape.com/article/796892-overview). Medscape. Retrieved 2025-03-14. 13. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-13) Befekadu Tesfaye Oyato (2024-06-20). ["Determinants of puerperal sepsis among postpartum women: a case–control study in East Shoa Zone public hospitals, Central Ethiopia"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328626). BMJ Open. 14 (6) e083230. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmjopen-2023-083230](https://doi.org/10.1136%2Fbmjopen-2023-083230). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [11328626](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328626). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [38908838](https://pubmed.ncbi.nlm.nih.gov/38908838). 14. ^ [*a](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-gfmer.ch_14-0) [b](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-gfmer.ch_14-1) [The Global Incidence of Puerperal Sepsis Protocol for a Systematic Review](http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf) [Archived](https://web.archive.org/web/20081217023721/http://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Chisembele_Puerperal_sepsis.pdf) 2008-12-17 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 15. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-15)* Carter (2005):98 16. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-16) Berenson AB (April 1990). ["Bacteriologic Findings of Post-Cesarian Endometritis in Adolescents"](http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx). Obstetrics and Gynecology. 75 (4): 627–629\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [2314783](https://pubmed.ncbi.nlm.nih.gov/2314783). [Archived](https://web.archive.org/web/20131103084443/http://journals.lww.com/greenjournal/abstract/1990/04000/bacteriologic_findings_of_post_cesarean.12.aspx) from the original on 2013-11-03. 17. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-17) ["Atelectasis"](https://www.lecturio.com/concepts/atelectasis/). The Lecturio Medical Concept Library. Retrieved 7 July 2021. 18. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-18) ["Urinary Tract Infection"](https://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html). [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC). 17 April 2015. [Archived](https://web.archive.org/web/20160222034940/http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/uti.html) from the original on 22 February 2016. Retrieved 7 July 2021. 19. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-19) Crum CP, Lee KR, Nucci MR (2011). [Diagnostic Gynecologic and Obstetric Pathology E-Book](https://books.google.com/books?id=d91mO9WYtPYC&pg=PA430). Elsevier Health Sciences. p. 430. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-0895-6](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-0895-6 "Special:BookSources/978-1-4557-0895-6") . 20. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-20) [Definition of "infection" from several medical dictionaries](http://medical-dictionary.thefreedictionary.com/infection) – Retrieved on 2021-07-07 21. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-21) Callaghan T. Blueprint Obstetrics and Gynecology. 22. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-22) Berens PD (December 2015). ["Breast Pain: Engorgement, Nipple Pain, and Mastitis"](https://semanticscholar.org/paper/a3f96251efd59a92f82ed618dda1fea955027fbe). Clinical Obstetrics and Gynecology. 58 (4): 902–14\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/GRF.0000000000000153](https://doi.org/10.1097%2FGRF.0000000000000153). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26512442](https://pubmed.ncbi.nlm.nih.gov/26512442). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [13006527](https://api.semanticscholar.org/CorpusID:13006527). 23. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-23) ["WHO recommendations for prevention and treatment of maternal peripartum infections"](http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1) (PDF). [Archived](https://web.archive.org/web/20160306061338/http://apps.who.int/iris/bitstream/10665/186171/1/9789241549363_eng.pdf?ua=1) (PDF) from the original on 2016-03-06. 24. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-24) Carter KC, Carter BR (2005). Childbed fever. A scientific biography of Ignaz Semmelweis. Transaction Publishers. p. 100. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4128-0467-7](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4128-0467-7 "Special:BookSources/978-1-4128-0467-7") . 25. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-25) [Lewis G](https://en.wikipedia.org/wiki/Gwyneth_Lewis_\(scientist\) "Gwyneth Lewis (scientist)"), ed. (2007). [Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom](http://www.cemach.org.uk/getattachment/8f5c1ed8-fdf3-489b-a182-e53955bec07b/Saving-Mothers--Lives-2003%E2%80%932005_full.aspx). CEMACH. p. 97. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-9533536-8-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-9533536-8-2 "Special:BookSources/978-0-9533536-8-2") . \[[permanent dead link](https://en.wikipedia.org/wiki/Wikipedia:Link_rot "Wikipedia:Link rot")\] 26. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-26) [CEMACH: Saving Mothers' Lives 2003–2005](http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx) [Archived](https://web.archive.org/web/20080521093900/http://www.cemach.org.uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health.aspx) 2008-05-21 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 27. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-27) [Loudon I](https://en.wikipedia.org/wiki/Irvine_Loudon "Irvine Loudon") (9 March 2000). [The Tragedy of Childbed Fever](https://web.archive.org/web/20120211075531/http://fds.oup.com/www.oup.co.uk/pdf/0-19-820499-X.pdf) (PDF). Oxford University Press, USA. p. 6. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-19-820499-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-820499-2 "Special:BookSources/978-0-19-820499-2") . Archived from [the original](http://fds.oup.com/www.oup.co.uk/pdf/0-19-820499-X.pdf) (PDF) on 11 February 2012. 28. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-28) The debate about when this term first emerged is presented by Irvine Loudon, The Tragedy of Childbed Fever, Oxford University Press, 2000, p. 8. 29. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-29) Basetti S, Hodgson J, Rawson TM, Majeed A (2017-08-11). ["Scarlet fever: a guide for general practitioners"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319). London Journal of Primary Care. 9 (5): 77–79\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/17571472.2017.1365677](https://doi.org/10.1080%2F17571472.2017.1365677). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1757-1472](https://search.worldcat.org/issn/1757-1472). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5649319](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29081840](https://pubmed.ncbi.nlm.nih.gov/29081840). 30. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-30) Rebecca Davis (2015-01-12). ["The doctor who championed hand-washing and saved women's lives"](https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives). [National Public Radio](https://en.wikipedia.org/wiki/National_Public_Radio "National Public Radio"). Retrieved 2025-03-14. 31. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-31) Loudon I. "Deaths in childbed from the eighteenth century to 1935". Med History 1986; 30: 1–41 32. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-32) Caplan CE (1995). ["The Childbed Fever Mystery and the Meaning of Medical Journalism"](https://web.archive.org/web/20120707205101/http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html). McGill Journal of Medicine. 1 (1). Archived from [the original](http://www.med.mcgill.ca/mjm/issues/v01n01/fever.html) on 2012-07-07. 33. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Ignaz_Semmelweis_33-0) Wyklicky H, Skopec M (1983). "Ignaz Philipp Semmelweis, the prophet of bacteriology". Infect Control. 4 (5): 367–370\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1017/S0195941700059762](https://doi.org/10.1017%2FS0195941700059762). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [6354955](https://pubmed.ncbi.nlm.nih.gov/6354955). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [25830725](https://api.semanticscholar.org/CorpusID:25830725). 34. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-childbed_fever_34-0) De Costa CM (Nov 2002). [""The contagiousness of childbed fever": a short history of puerperal sepsis and its treatment"](http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html). The Medical Journal of Australia. 177 (11–12\): 668–671\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5694/j.1326-5377.2002.tb05004.x](https://doi.org/10.5694%2Fj.1326-5377.2002.tb05004.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12463995](https://pubmed.ncbi.nlm.nih.gov/12463995). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12164328](https://api.semanticscholar.org/CorpusID:12164328). [Archived](https://web.archive.org/web/20061203030203/http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html) from the original on 2006-12-03. 35. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-35) Gordon A (1795). [A Treatise on the Epidemic Puerperal Fever of Aberdeen](https://archive.org/details/treatiseonepidem00gord). London, England: G.G. and J. Robinson. pp. [63](https://archive.org/details/treatiseonepidem00gord/page/63)–64. On p. 63, Gordon recognized that puerperal fever was infectious: "But this disease seized such women only, as were visited, or delivered, by a practitioner, or taken care of by a nurse, who had previously attended patients affected with the disease. In short, I had evident proofs of its infectious nature, and that the infection was as readily communicated as that of smallpox, or measles, and operated more speedily than any other infection, with which I am acquainted." From p. 64: "It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women." 36. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-Dr_Alexander_Gordon_36-0) ["Treatise on the Epidemic of Puerperal Fever"](https://web.archive.org/web/20080720005441/http://www.general-anaesthesia.com/images/ignaz-semmelweis.html). www.general-anaesthesia.com. Archived from [the original](https://www.general-anaesthesia.com/images/ignaz-semmelweis.html) on July 20, 2008. Retrieved September 15, 2011. 37. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-37) Watson (February 18, 1842). ["Lectures on the principles and practice of physic: Diseases of the abdomen"](https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=811). The London Medical Gazette. 29: 801–808\. [From p. 806](https://babel.hathitrust.org/cgi/pt?id=mdp.39015018029671&view=1up&seq=816): "Whenever puerperal fever is rife, or when a practitioner has attended any one example of it, he should use most diligent ablution; he should even wash his hands with some disinfecting fluid, a weak solution of chlorine for instance: he should avoid going in the same dress to any other of his midwifery patients: in short, he should take all those precautions which, when the danger is understood, common sense will suggest, against his clothes or his body becoming a vehicle of contagion and death between one patient and another." 38. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-38) [The Medical Journal of Australia."The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment"](http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html#i1067496) [Archived](https://web.archive.org/web/20061203030203/http://www.mja.com.au/public/issues/177_11_021202/dec10354_fm.html) 2006-12-03 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 39. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-39) Holmes OW (1842–1843). ["On the contagiousness of puerperal fever"](https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=513). The New England Quarterly Journal of Medicine. 1: 503–530\. 40. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-bartleby.com_40-0) [Oliver Wendell Holmes: The Contagiousness of Puerperal Fever](http://www.bartleby.com/38/5/1.html) [Archived](https://web.archive.org/web/20070203165344/http://www.bartleby.com/38/5/1.html) 2007-02-03 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") 41. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-41) (Holmes, 1842–1843), [p. 510.](https://babel.hathitrust.org/cgi/pt?id=mdp.39015059415961&view=1up&seq=520) 42. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-42) Meigs CD (1854). [On the Nature, Signs, and Treatment of Childbed Fevers: In a Series of Letters Addressed to the Students of His Class](https://archive.org/details/onnaturesignstre1854meig). Philadelphia, Pennsylvania: Blanchard and Lea. p. [104](https://archive.org/details/onnaturesignstre1854meig/page/104). From p. 104: Speaking of a physician in Philadelphia, Pennsylvania, Meigs said: "He is a gentlemen who is scrupulously careful of his personal appearance, … But a gentleman's hands are clean." 43. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GordononMotherhood_43-0) [Gordon R](https://en.wikipedia.org/wiki/Richard_Gordon_\(English_author\) "Richard Gordon (English author)") (1983). "Disastrous Motherhood: Tales from the Vienna Wards". Great Medical Disasters. London: Hutchinson & Co. pp. 43–46 \[43\]. 44. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-44) Treves F (1923). "Ch. 2: The Old Receiving Room". [The Elephant Man and Other Reminiscences](https://archive.org/details/elephantmanother00trevuoft). London, England: Cassell and Company, Ltd. pp. [56](https://archive.org/details/elephantmanother00trevuoft/page/56)–57. 45. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-GordononMotherhood44_45-0) Gordon, Richard (1983) p. 44 46. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-raju_46-0) Raju TN (1999). "Ignác Semmelweis and the etiology of fetal and neonatal sepsis". Journal of Perinatology. 19 (4): 307–310\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/sj.jp.7200155](https://doi.org/10.1038%2Fsj.jp.7200155). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10685244](https://pubmed.ncbi.nlm.nih.gov/10685244). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [29047987](https://api.semanticscholar.org/CorpusID:29047987). 47. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-colyer_47-0) Christa Colyer.["Childbed fever: a nineteenth-century mystery,"](http://www.sciencecases.org/childbed_fever/childbed_fever.asp) [Archived](https://web.archive.org/web/20090416054052/http://www.sciencecases.org/childbed_fever/childbed_fever.asp) 2009-04-16 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") National Center for Case Study Teaching in Science, December 8, 1999 (revised October 27, 2003). 48. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-48) Colebrook, L; Kenny, M (June 6, 1936). "Treatment of Human Puerperal Infections, and of Experimental Infections in Mice, with Prontosil".Lancet 227(1): 1279–1286. 49. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-49) Sue Bale, Vanessa Jones (2006). [Wound care nursing](https://books.google.com/books?id=zbIuXxpoRXMC&q=fireguards+act+1952&pg=PA54). Elsevier Health Sciences. p. 54. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7234-3344-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7234-3344-6 "Special:BookSources/978-0-7234-3344-6") . Retrieved 2009-08-05. 50. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-50) Sophie Campbell (2012-08-14). ["Sudeley Castle: the curious life and death of Katherine Parr"](https://www.telegraph.co.uk/travel/destinations/europe/united-kingdom/england/cotswolds/articles/Sudeley-Castle-the-curious-life-and-death-of-Katherine-Parr/). The Telegraph. Retrieved 2025-03-14. 51. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-51) Quoted from [Will Durant](https://en.wikipedia.org/wiki/Will_Durant "Will Durant")'s "The Age of Rousseau".\[[full citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citing_sources#What_information_to_include "Wikipedia:Citing sources")\] 52. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-52) Beetham M (2004). ["Beeton, Samuel Orchart (1831–1877)"](http://www.oxforddnb.com/view/article/45481). [Oxford Dictionary of National Biography](https://en.wikipedia.org/wiki/Dictionary_of_National_Biography#Oxford_Dictionary_of_National_Biography "Dictionary of National Biography") (online ed.). Oxford University Press. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/ref:odnb/45481](https://doi.org/10.1093%2Fref%3Aodnb%2F45481). Retrieved 23 November 2015. `{{cite encyclopedia}}`: CS1 maint: ref duplicates default ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_ref_duplicates_default "Category:CS1 maint: ref duplicates default")) (Subscription, [Wikipedia Library](https://wikipedialibrary.wmflabs.org/partners/88/) access or [UK public library membership](https://www.oxforddnb.com/help/subscribe#public) required.) 53. [^](https://en.wikipedia.org/wiki/Postpartum_infections#cite_ref-53) [Hughes K](https://en.wikipedia.org/wiki/Kathryn_Hughes "Kathryn Hughes") (2006). [The Short Life and Long Times of Mrs Beeton](https://books.google.com/books?id=p5NvuLMB3tYC&pg=PP1). London: HarperCollins Publishers. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-7524-6122-9](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7524-6122-9 "Special:BookSources/978-0-7524-6122-9") . - Chaim W, Burstein E (August 2003). "Postpartum infection treatments: a review". Expert Opinion on Pharmacotherapy (review). 4 (8): 1297–313\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1517/14656566.4.8.1297](https://doi.org/10.1517%2F14656566.4.8.1297). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12877638](https://pubmed.ncbi.nlm.nih.gov/12877638). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [26781321](https://api.semanticscholar.org/CorpusID:26781321). - French L (August 2003). "Prevention and treatment of postpartum endometritis". Current Women's Health Reports (review). 3 (4): 274–9\. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12844449](https://pubmed.ncbi.nlm.nih.gov/12844449). - Calhoun BC, Brost B (June 1995). "Emergency management of sudden puerperal fever". Obstetrics and Gynecology Clinics of North America (review). 22 (2): 357–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0889-8545(21)00185-6](https://doi.org/10.1016%2FS0889-8545%2821%2900185-6). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [7651676](https://pubmed.ncbi.nlm.nih.gov/7651676).
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