From the Guidelines
Traumatic delivery is a significant risk factor for postpartum sepsis due to the creation of entry points for bacteria through tears, lacerations, and wounds in the genital tract, as well as the potential for retained tissue and hematomas that can serve as growth media for pathogens. During difficult deliveries, procedures like episiotomies, forceps or vacuum-assisted deliveries, and emergency cesarean sections can damage tissue integrity, creating environments where bacteria can colonize and multiply 1. These injuries may cause hematomas or retained tissue that serve as excellent growth media for pathogens. Additionally, prolonged labor associated with traumatic deliveries increases the number of vaginal examinations, each introducing potential contaminants. The body's natural immune defenses may also be compromised due to blood loss and stress from a difficult delivery.
Some key points to consider in the management of traumatic deliveries to reduce the risk of postpartum sepsis include:
- Ensuring proper wound care to prevent infection
- Administering prophylactic antibiotics when indicated, such as a single dose of a broad-spectrum antibiotic like cefazolin 1-2g IV for cesarean deliveries
- Maintaining strict aseptic technique during procedures
- Closely monitoring for early signs of infection such as fever, increased pain, or foul-smelling discharge in the postpartum period
- Being aware of the potential for rapid clinical deterioration in cases of postpartum sepsis, as illustrated by a study that found a median time to death of only 18 hours after infection was identified 1.
It is essential to prioritize these measures to minimize the risk of postpartum sepsis and ensure the best possible outcomes for patients who have experienced traumatic deliveries.
From the Research
Traumatic Delivery as a Risk Factor for Postpartum Sepsis
- Traumatic delivery can increase the risk of postpartum sepsis due to various factors, including:
- Intrapartum fever, which can lead to inflammation and hyperthermia, increasing the risk of uterine contractility and postpartum hemorrhage 2
- Cesarean delivery, which is a known risk factor for postpartum sepsis, especially if the cesarean is performed under emergency conditions or if there are complications during the procedure 3, 4
- Hemorrhage, which can lead to infection and sepsis if not managed properly 3, 4
- The studies suggest that traumatic delivery can lead to a range of complications, including:
- The evidence highlights the importance of:
- Early recognition and treatment of intrapartum fever and other complications during delivery 2
- Proper management of cesarean deliveries and postpartum care to reduce the risk of infection and sepsis 3, 4
- Close monitoring of women who have experienced traumatic delivery for signs of infection and sepsis, and prompt treatment if necessary 5, 6