puerperal fever, a syndrome associated with systemic bacterial infection and septicemia that occurs after childbirth, usually as a result of unsterile obstetric technique. It is characterized by endometritis, fever, tachycardia, uterine tenderness, and foul lochia. If it is untreated, prostration, renal failure, bacteremic shock, and death may occur. The causative organism is most often one of the hemolytic streptococci. Puerperal fever was little known before hospital childbirth became common, early in the 19th century; then it became an endemic and frequently epidemic scourge that resulted in the deaths of many thousands of mothers and infants. Maternal mortality rates of 20% and higher were common in parts of the world where childbirth occurred in hospitals. Ignaz Philipp Semmelweis, in Vienna, noted that women attended by midwives were much less likely to contract the disease than those attended by physicians and medical students. Midwives did not perform frequent vaginal examinations during labor and did not participate in autopsies. Although the germ theory of disease had not yet been elaborated, Semmelweis deduced that the causative agent of the disease was being transmitted by doctors and students from the infected cadavers in the autopsy room to women in labor on the maternity wards. After institution of a policy requiring that the hands and instruments of obstetric attendants be disinfected, the maternal mortality rate in his clinic dropped dramatically. His work was widely ignored or discredited for almost half a century because physicians were unwilling to believe that they were the agents of transmission. Late in the 19th century, after Pasteur’s discovery of microbes, Semmelweis was posthumously vindicated. Sterile techniques were gradually instituted, but not until the fourth decade of the 20th century did puerperal fever cease to be the leading cause of maternal death. Postpartum uterine infection is common but is effectively treated with massive parenteral doses of antibiotics before it becomes a systemic illness. Also called childbed fever, puerperal sepsis.
