Postpartum Sepsis Causes Mnemonic
The classic mnemonic for postpartum sepsis causes is "The 7 W's" or variations including "The 5 T's", though the provided evidence does not explicitly reference a standardized mnemonic in recent guidelines 1. However, based on clinical practice and the sources of infection discussed in maternal sepsis literature, the traditional teaching mnemonic is:
The 7 W's of Postpartum Fever/Sepsis:
- Womb (endometritis/endomyometritis) - the most common cause of postpartum infection 2, 3
- Wound (cesarean section or perineal laceration infection) 2
- Water (urinary tract infection/pyelonephritis) 2
- Walk (thrombophlebitis/deep vein thrombosis with associated inflammation) 2
- Wonder drugs (drug fever - less common) 2
- Weaning (mastitis/breast engorgement/abscess) 2
- Wind (pneumonia/atelectasis) 2
Alternative: The 5 T's (More Obstetric-Specific):
- Tissue (retained products of conception with infection) 2
- Thrombophlebitis (septic pelvic thrombophlebitis) 2
- Trauma (infected lacerations, episiotomy, or cesarean wound) 2
- Tract (urinary tract infection) 2
- Teat (mastitis) 2
Critical Clinical Context:
Approximately half of maternal sepsis cases occur in the postdischarge postpartum period, making outpatient recognition crucial 1, 4. The most common sources are endometritis and wound infections, followed by urinary tract infections 2, 3.
Key Recognition Points:
- Maternal sepsis is the second leading cause of preventable maternal mortality 1, 5, 6
- Diagnosis requires suspected/confirmed infection PLUS evidence of end-organ dysfunction, not just fever 2, 3
- If uterine source is suspected, prompt delivery or evacuation of uterine contents is required regardless of gestational age 2
- Screening should use obstetrically modified SIRS (omSIRS) criteria for pregnant patients 20 weeks through 3 days postpartum 1
Common Pitfall:
Do not rely on fever alone - sepsis can present without fever, and normal physiologic changes of pregnancy overlap with sepsis symptoms, making diagnosis challenging 2, 6. Always consider sepsis with unexplained end-organ damage in the presence of suspected infection 2.