Fever after cesarean section: What you need to know

The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Obstetrics & Gynecology - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital

Fever after cesarean section is a condition in which a fever occurs more than 24 hours after surgery with a body temperature of 38oC or higher. This is a symptom of many different causes with varying degrees of severity.

There are many causes of fever after cesarean section with different severity and severity.
Breast diseases such as postpartum breast engorgement but also mastitis, breast abscess, engorgement. Cesarean section infection (cystitis, acute pyelonephritis, pneumonia...) or possible post-cesarean section infection (vaginal, vaginal, perineal infection. , pancreatitis, adnexitis, pelvic peritonitis, generalized peritonitis, sepsis).

2.1. Postpartum fever due to breast diseases Usually after giving birth, women often get breast engorgement due to milk engorgement. At this time, the mother needs to increase the number of feedings, which can be expressed by hand or with a pump. To relieve pain after breastfeeding, you need to apply cold compresses, wear bras or bandages that are not too tight. In this case, no medical facility is required.
Mothers need to go to the doctor if mastitis with main signs such as fever, breast erection, pain, redness, cracked nipples, usually on one side, otherwise the disease will progress to breast abscess. The main signs of breast abscess will be enlarged, red, swollen, tender places, if there is pus in the puncture.
2.2. Fever due to cesarean section infection: This is a condition in which the cesarean section is swollen, has blood or pus discharge, and is red around the stitches, requiring immediate medical attention for treatment.

2.3. Fever due to infection in the perineum, vulva, vagina, cervix The main symptom is a tear or suture at the cesarean section, which is swollen, red, painful, sometimes with pus. The uterus is in good contraction, the discharge may be foul or very foul. A pregnant woman may have a slight fever of 38 - 38.5 degrees Celsius, at this time she needs to go to a medical facility for examination and treatment.
2.4. Febrile endometritis: This is a complication after cesarean section caused by uterine control, amniotic infection, prolonged labor or sometimes may be due to retained placenta. If endometritis is not treated, it will lead to more serious complications such as total uterine inflammation, peritonitis, sepsis... With clinical symptoms of fatigue, the mother has a fever of 38 degrees. C - 39 degrees C from the 2nd day postpartum cesarean section. The uterus contracts slowly, is soft, and painful to press. The discharge has a bad smell, sometimes mixed with pus... Pregnant women need to go to a medical facility immediately for examination and treatment.
2.5. Fever due to inflammation of the uterus and appendages: From the uterus, the post-cesarean section infection can spread to the surrounding organs such as the broad ligament, fallopian tubes, ovaries... The main symptom is usually appear late 8 - 10 days after birth. Pregnant women will have persistent high fever and lower abdominal pain. Large uterus, slow contraction, painful pressure... can cause complications of peritonitis or pus bags burst into the bladder, vagina, rectum, which is very dangerous.
2.6. Fever due to pelvic peritonitis: Symptoms may appear as early as 3 days after delivery or as late as 7 - 10 days after a period of postpartum infection in the uterus or vulva, vagina. . The mother has a high fever of 39 degrees C - 40 degrees C, accompanied by chills. Severe pain in the lower abdomen, abdominal pressure is responsive in this area.
2.7. Fever due to generalized peritonitis: The main symptoms are generalized fatigue, high fever, weight loss, rapid pulse, shortness of breath, vomiting. Abdominal distension, pain, if not treated, can cause total peritonitis, requiring hysterectomy.
2.8. Fever caused by sepsis: This case is caused by obstetric intervention or non-sterile instruments. Due to improper treatment of infectious conditions, inadequate antibiotic use, insufficient time... It may be due to too early surgical intervention when the localized infection in the genitals has not been covered. with antibiotics, allowing bacteria to spread into the bloodstream. The main symptom is high fever, chills several times a day. There are cases of prolonged fever, general weakness, which can lead to shock, hypotension, and coma. If not treated promptly, mildly, severe hysterectomy will result in the death of the mother.
2.9. Thrombophlebitis is a rare disease in our country. Usually appears on the 18th day postpartum with cesarean section with clinical symptoms: High fever, pain at the site of thrombophlebitis, the patient can't walk if the veins are blocked in the lower extremities. If the inflammation of the veins in the abdomen is blocked, the patient will have abdominal pain, especially mesenteric thrombophlebitis, the disease can manifest in the veins in the lungs, in the brain... with symptoms of pain in the organs. In this case, sometimes paralysis if the clot is obstructing can be surgically removed.

In order to avoid complications of fever after cesarean section, pregnant women need to pay attention to preserve the incision to avoid infection and avoid breast engorgement, milk ...
Early detection of infection at the cesarean site. If the incision site is red, swollen, painful, or has a yellow discharge, you need to go to a specialist hospital for examination.
Increase movement: after giving birth, women should not lie motionless on the bed, need to turn to lie on the right or left side, in the first day after surgery. From day 2 onwards, the mother should sit up and walk.
Should massage the abdomen (avoid cesarean section) every day to help the uterus contract well and push the fluid out faster. Need to breastfeed the baby early, breastfeeding also increases the contraction of the uterus, avoiding bleeding after cesarean section.
Personal hygiene, body hygiene: wipe the body with warm water or take a quick shower, avoid soaking the body in the bath that makes the cesarean section wet. After bathing, use a clean cotton ball to dry the incision, leave the open incision without a bandage, and keep the incision clean and dry. The incision can be cleaned with a solution of betadine or povidine 10%, which helps the incision heal quickly and avoid infection of the cesarean section.
>> See more: Prevention and treatment of chills in cesarean section - Posted by Specialist Doctor II Nguyen Thi Hoai Nam - Head of Pain Relief Unit - Department of Surgical Anesthesia - Vinmec International General Hospital Central Park

Reference source: National guide to reproductive health services, Ministry of Health.