Puerperal Pyrexia

A puerperal pyrexiais defined as a rise in temperature on one or more occasionsduring the first 28 days after a woman has been delivered. It used to be a statutory requirement for a puerperal pyrexiato be notified to the local medical officer of health. This was a legacy dating back 50 or 60 years to the time when puerperal pyrexiawas very much feared as a disease which killed quite a large number of newly delivered mothers. Puerperal pyrexia is any febrile condition occurring in a woman in whom a temperature of 38.0 degrees centigrade or more has occurred within 14 days after confinement or miscarriage. It is a result of infection. Up to 60 years ago, if a vicious infection gained access to the uterus, it was uncontrollable because no satisfactory treatment existed and it could spread from one woman to another with alarming speed.

The control and cure of puerperal infection beganin 1935 with the introduction of the first sulphonamides, and as bet-ter sulphonamides and subsequently antibiotics were introduced puerperal fever became controllable. It is today a preventable disease. The organism most feared was the haemolyric streptococcus, which was eventually conquered by the use of penicillin, to which it is nearly always sensitive. Puerperal pyrexia today is a condition that is treated with respect, but it is no longer feared or notified, because the bacteria that cause puerperal pyrexia are easily controlled by modern antibiotics.

Up to 1935 many women dared not have their babies in hospital because of the risk of contracting puerperal fever by cross infection. This argumentis still put forward by some people for preferring home to hospital confinement. The incidence, however, of all types of puerperal pyrexia today is less than 4 per cent and then the infection is usually in the urinary tract. Severe infections of the uterus are extremely rare, so much so that it is difficult to appreciate the severity of puerperal fever that existed only i1few decades ago.

The reasons for the reduction in puerperal infection are many and a full appreciation of their extent can only be achieved if one considers all the preventive measures as well as those used in the early treatment of the condition. Samples of urine are taken during pregnancy to detect those women in whom a urinary tract infection is liable to occur. These infections are treated vigorously in the antenatal period. Swabs are taken of any discharge and the organisms cultured so that they can be eliminated before the onset of labour. The care of breasts and instructions given to facilitate breast-feeding during the antenatal period render them less liable to infection. The prevention of anaemia and the correction of many other minor abnormalities or deficiencies during pregnancy all help to avoid puerperal infection.

Rigid antiseptic measures taken during labour and delivery also help to eliminate infection. The cleansing of the vulva, the use of antiseptic creams and lotions during examinations, the avoidance of catheterization if poss-ble, the use of sterile instruments and towels, as well as the extensive measures taken to ensure that infection should not be passed from the midwife or doctor to the patient, are just a few of the aspectsin the care of the pregnant woman which have gone such a long way towards the control of infection.

Last, and probably most important, is that when an infection does begin the organism can be be rapidly cultured, isolated "and killed with an antibiotic before it has had time to cause damage to the woman herself or be transmitted to another person.