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Is there any other form of pelvic infection occurring in the puerperium?
Yes. Though uncommon, it deserves special separate mention because of its distinctive form of management. This is septic thrombo-phlebitis. Pelvic veins may become infected, leading to clot formation within their cavities. It almost always follows caesarean section rather than vaginal delivery.
Once diagnosed, medication to thin the blood will have to be commenced alongside antibiotics. Blood-thinning medication will be in the form of heparin injections (to begin with). This may be changed later to oral medication (warfarin), if required. Both these drugs are safe for breastfeeding.
In very rare instances, it may be necessary to insert a filter in the major abdominal vein to prevent more serious consequences while continuing with treatment.
What about "water" infections?
Urinary tract infection (UTI) is not uncommon following delivery. This is understandable, considering the circumstances surrounding labour and delivery itself. There may be prolonged periods of stoppage of urinary flow in the bladder. Catheterization is also more common, usually to prevent over-distension of the bladder and to ease the descent of the baby into the pelvis.
All these increase the risk of subsequent urinary tract infection. The infection hardly ever extends beyond the bladder.
The symptoms of a UTI usually frequency of voiding, urgency and a burning sensation when passing water. Occasionally there may be more generalized symptoms such as malaise and fever. This increases the possibility that the infection has extended higher, to the kidneys.
With symptoms like these, a urine sample is taken for urgent analysis and broad-spectrum antibiotics commenced. Relief is felt within a day or so, even though antibiotics will have to be taken for at least seven days, sometimes more, to ensure eradication of the infection.
Blood clots (thrombosis) post-delivery
What is thrombo-embolism?
Thrombosis or clot-formation within the veins is one of the potential complications of pregnancy. When a clot is dislodged and transported within the bloodstream to distant organs (usually the lungs), this is called thrombo-embolism. It can be a serious - even fatal - condition.
In the Western world, it is one of the leading causes of maternal death.
How common is thrombo-embolism in pregnancy?
Deep vein thrombosis - commonly known by its short form, DVT - occurs in about 0.1 per cent of all pregnancies. It therefore means that, in an average general district hospital, with an annual delivery rate of about 3000 babies, they will expect to have three or four cases of DVT per year.
The risk of DVT increases with advancing pregnancy and is greatest in the early puerperium. It then gradually lessens. The veins usually affected are those in the lower limbs (calf or thigh) and, to a lesser extent, the pelvic veins.
The risk of pelvic vein thrombosis is significantly increased by caesarean section.
Is there anything that can be done to reduce the risk of thrombosis in the puerperium?
Yes. Getting on your feet quickly helps to reduce the risk of puerperal thrombosis. It is therefore imperative upon midwives looking after new mothers to encourage them to get on their feet as early as is practicable and being ambulant as much as possible. If this is not practical, wearing compression stockings most of the time is encouraged.