What are the key clinical signs and symptoms of puerperal sepsis that I should look for in postpartum patients?

Key clinical signs and symptoms of puerperal sepsis to look for in postpartum patients include:

• Fever or elevated temperature, typically 38°C or above on a single reading, or 37.5°C or above on two consecutive readings an hour apart.
• Abdominal, pelvic, or perineal pain.
• Shivering or chills.
• Vaginal discharge with an unpleasant smell, which may indicate infection.
• Signs of systemic infection such as increased pulse rate, respiratory rate, and altered level of consciousness.
• Signs of organ dysfunction such as hypotension (systolic blood pressure less than 90 mmHg), reduced urine output (less than 0.5 ml/kg per hour), or need for supplemental oxygen to maintain saturation above 92%.

Women may also present with sudden or very heavy vaginal bleeding or persistent/increased bleeding, which could indicate retained placental tissue or endometritis, a common source of puerperal sepsis.

It is important to assess these signs promptly and consider microbiological cultures and antimicrobial treatment as per clinical guidelines.

Women should be advised to seek medical advice without delay if they experience these symptoms postpartum.

Close monitoring of vital signs including temperature, pulse, blood pressure, respiratory rate, oxygen saturation, and level of consciousness is essential in suspected cases.

Early recognition and multidisciplinary management are critical to reduce the risk of severe illness or death.

References: ¹,²