Diagnostics
On the one hand, the fever in childbed fever is longer and higher than in endometrial inflammation, and on the other hand, the symptoms such as increased pulse (tachycardia) and restlessness of the patient are leading the way. In addition, the lochia (lochia) smells foul, which is caused by the decomposition products of the bacteria. This smell is usually caused by the sulfur-containing decomposition products of the bacteria. The uterus is painful under pressure and has little regression. A clinical suspicion is sufficient to start the therapy, but a vaginal smear can be taken to confirm the diagnosis.
Therapy
Since postpartum fever is a bacterial infection, a high-dose broad-spectrum antibiotic is administered in case of suspicion until it is clear what exactly the bacterial pathogen is. Then it is possible to switch to a calculated, custom-fit antibiotic. Since puerperal fever is a rare, but nevertheless severe to fatal disease, a fast start of therapy is absolutely necessary.
If the puerperal fever turns into blood poisoning (puerperal sepsis), a drop in the blood platelets (thrombocytes) can also occur, which can then be the cause of heavy bleeding and can therefore be treated with thrombocyte concentrates, for example. The body’s own oxytocin also has a contracting effect on the uterus and is usually given in combination with methylergotermine. Methylergotermin belongs to the ergot alkaloids and has a re-forming effect on the uterus.
A scraping (curettage) of the uterus is also suitable for removing the inflamed tissue. In very severe cases, the removal of the uterus (hysterectomy) can also be considered. It should be noted that this is a difficult procedure, as surgery is performed in the inflamed tissue, and that it is a final, irreversible step. Of course, this also means that the affected patients can no longer become pregnant.
Prognosis
If antibiotic therapy is started in time, the prognosis is good, as postpartum fever can heal without further consequences. Of course, the prerequisite for this is an early diagnosis and a calculated antibiotic therapy started in time. However, if blood poisoning occurs in the further course of the disease, the mortality rate is 20-50%. This again shows how essential early treatment with an antibiotic is.
