Historically the terms puerperal fever and childbed fever referred to any acute fever occurring in puerperae during the first few days after delivery. Less frequently, the terms were also applied to symptomatically similar diseases that occurred during pregnancy or even among the newborn. From a modern point of view, what was formerly called puerperal fever includes a range of disorders most of which would now be referred to as puerperal sepsis. Typically, puerperal sepsis involves postpartum infection in the pelvic region, but it can refer to disorders focused in other areas, such as mastitis. In modern usage, the term puerperal fever occurs mainly in discussions of the great fever epidemics that afflicted maternity clinics in earlier centuries.

Etiology and Epidemiology

A wide range of aerobic and anaerobic microorganisms have been associated with acute pelvic inflammation and with other postpartum inflammations that could be identified as puerperal fever. Group A streptococci (pyogenes) were probably the leading causal agent in most puerperal fever epidemics in earlier centuries. However, since the 1970s, group B streptococci (agalactiae) have become the most prevalent causal agent.

Clinical Manifestations and Pathology

Among puerperae the clinical manifestations of puerperal sepsis include acute fever, profuse lochial flow, and an enlarged and tender uterus. Onset is generally between 2 and 5 days after delivery. Normally there is inflammation of the endometrium and surrounding structures as well as of the lymphatic and vascular systems. One also finds pelvic cellulitis, septic pelvic thrombophlebitis, peritonitis, and pelvic abscesses. Among neonates, infection usually becomes apparent in the first 5 days after birth, but onset is sometimes delayed by several weeks. Symptoms include lethargy, poor feeding, and abnormal temperature. Infection by group B streptococci is often clinically indistinguishable from other bacterial infections.