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Infectious Disorders - Drug Targets


ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Systematic Review Article

Factors Affecting Postpartum Infection: A Systematic Review

Author(s): Maryam Malmir, Narges Azizi Boroojerdi, Seyedeh Zahra Masoumi* and Parisa Parsa

Volume 22, Issue 3, 2022

Published on: 23 December, 2021

Article ID: e291121198367 Pages: 10

DOI: 10.2174/1871526521666211129100519

Price: $65


Background: Puerperal infection is used to describe any bacterial infection of the reproductive tract after delivery. Identifying the factors affecting postpartum infections can reduce the risk and complications of such factors and postpartum maternal mortality.

Objective: This structured study was designed to evaluate factors affecting postpartum infections.

Methods: In this study, after selecting Scopus, PubMed, SID, and Web of Science electronic databases, all observational studies (cohort and case-control) available and published in Farsi and English to investigate factors affecting postpartum infections were searched. The search was performed using the terms postpartum, infection, wound infection, puerperium, reason, risk factor, and their equivalent Persian words from 2010 to November 2019 regardless of publication status.

Results: Out of the 3227 studies obtained, 19 were reviewed after removing irrelevant articles, duplicates (shared in databases), and animal samples. Age, level of education, delivery method, presence of episiotomy, anemia due to postpartum hemorrhage, interventions and manipulations during childbirth, prenatal hygiene, Povidone Iodine usage before delivery to wash the vagina, antibiotic prevention, increased labor duration, obesity, and the presence of bacteria were common symptoms affecting postpartum infection.

Conclusion: In this study, the factors affecting postpartum infection have been identified, some of which are avoidable. Identifying these factors helps reduce postpartum infections and their complications.

Keywords: Infection, postpartum, effective, factors, systematic, review, environmental hazards, demographic variables.

Graphical Abstract
Cunningham FJ, Kenneth JL, Steven LB, Eds. Williams’s obstetrics. New York: McGraw-Hill Education/Medical 2018.
Bonet M, Souza JP, Abalos E, et al. The global maternal sepsis study and awareness campaign (GLOSS): study protocol. Reprod Health 2018; 15(1): 16.
[] [PMID: 29382352]
Tita AT, Hauth JC, Grimes A, Owen J, Stamm AM, Andrews WW. Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis. Obstet Gynecol 2008; 111(1): 51-6.
[] [PMID: 18165392]
Bonet M, Oladapo OT, Khan DN, Mathai M, Gülmezoglu AM. New WHO guidance on prevention and treatment of maternal peripartum infections. Lancet Glob Health 2015; 3(11): e667-8.
[] [PMID: 26429594]
Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000; 8(2): 77-82.
[<77:AID-IDOG3>3.0.CO;2-6] [PMID: 10805361]
Organization WH. Addressing the challenge of women’s health in Africa: report of the Commission on Women’s Health in the African Region. World Health Organization 2012.
Organization WH. Trends in maternal mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA. The World Bank and the United Nations Population Division 2014.
Motlagh ME. The prevalence of violence against women during pregnancy and postpartum in Iran. J Mazandaran Univ Med Sci 2017; 27(150): 78-88.
Goldenberg RL, McClure EM. Maternal, fetal and neonatal mortality: lessons learned from historical changes in high income countries and their potential application to low-income countries. Matern Health Neonatol Perinatol 2015; 1(1): 3.
[] [PMID: 27057321]
Koo Y-J. Puerperal septic shock and necrotizing fasciitis caused by Staphylococcus caprae and Escherichia coli. Yeungnam Univ J Med 2018; 35(2): 248-52.
[] [PMID: 31620604]
Feinstein U, Sheiner E, Levy A, Hallak M, Mazor M. Risk factors for arrest of descent during the second stage of labor. Int J Gynaecol Obstet 2002; 77(1): 7-14.
[] [PMID: 11929650]
Kaambo E, Africa C, Chambuso R, Passmore JS. Vaginal microbiomes associated with aerobic vaginitis and bacterial vaginosis. Front Public Health 2018; 6: 78.
[] [PMID: 29632854]
Aydogan P, Kahyaoglu S, Saygan S, Kaymak O, Mollamahmutoglu L, Danisman N. Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study. Eur Rev Med Pharmacol Sci 2014; 18(16): 2243-7.
[PMID: 25219820]
Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clin Diagn Res 2013; 7(12): 2701-3.
[] [PMID: 24551617]
Maleki S. Frequency of mycoplasma hominis and ureaplasma urealyticum in females with urogenital infections and habitual abortion history in Ahvaz, Iran using multiplex PCR. Jundishapur J Microbiol 2013; 6(6): e10088.
Hartling L, Milne A, Hamm MP, et al. Testing the Newcastle Ottawa Scale showed low reliability between individual reviewers. J Clin Epidemiol 2013; 66(9): 982-93.
[] [PMID: 23683848]
Ngonzi J, Bebell LM, Bazira J, et al. Risk Factors for vaginal colonization and relationship between bacterial vaginal colonization and in-hospital outcomes in women with obstructed labor in a Ugandan Regional Referral Hospital. Int J Microbiol 2018; 2018: 6579139.
[] [PMID: 30327672]
Valent AM, DeArmond C, Houston JM, et al. Effect of post–cesarean delivery oral cephalexin and metronidazole on surgical site infection among obese women: a randomized clinical trial. JAMA 2017; 318(11): 1026-34.
[] [PMID: 28975304]
Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis: a Scottish population-based case-control study. BJOG 2012; 119(4): 474-83.
[] [PMID: 22251396]
Mandal D, Manda S, Rakshi A, Dey RP, Biswas SC, Banerjee A. Maternal obesity and pregnancy outcome: a prospective analysis. J Assoc Physicians India 2011; 59: 486-9.
[PMID: 21887903]
Axelsson D, Blomberg M. Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers. Infect Dis (Lond) 2017; 49(10): 765-71.
[] [PMID: 28632072]
Axelsson D, Brynhildsen J, Blomberg M. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications. J Perinat Med 2018; 46(3): 271-8.
[] [PMID: 28672754]
Mascarello KC, Matijasevich A, Santos IDSD, Silveira MF. Early and late puerperal complications associated with the mode of delivery in a cohort in Brazil. Rev Bras Epidemiol 2018; 21: e180010.
[PMID: 30133598]
Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet 2011; 283(4): 735-41.
[] [PMID: 20354706]
Gundersen TD, Krebs L, Loekkegaard ECL, Rasmussen SC, Glavind J, Clausen TD. Postpartum urinary tract infection by mode of delivery: A Danish nationwide cohort study. BMJ Open 2018; 8(3): e018479.
[] [PMID: 29540408]
Ngonzi J, Bebell LM, Fajardo Y, et al. Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth 2018; 18(1): 270.
[] [PMID: 29954356]
Knight M, Mottram L, Gray S, Partlett C, Juszczak E. Prophylactic antibiotics for the prevention of infection following operative vaginal delivery (ANODE): study protocol for a randomised controlled trial. Trials 2018; 19(1): 395.
[] [PMID: 30041702]
Kodan LR. The golden hour of sepsis: an in-depth analysis of sepsis-related maternal mortality in middle-income country Suriname. PLoS One 2018; 13(7)
Charrier L, Serafini P, Ribatti A, Castella A, Rabacchi G, Zotti CM. Post-partum surgical wound infections: incidence after caesarean section in an Italian hospital. J Prev Med Hyg 2009; 50(3): 159-63.
[PMID: 20411649]
Harris B. Efficacy of non-beta lactam antibiotics for prevention of cesarean delivery wound infections. Am J Obstet Gynecol 2017; 217(6): 719.
[] [PMID: 31044099]
Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014; (10): CD007482.
[] [PMID: 25350672]
Bebell LM, Ngonzi J, Bazira J, et al. Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. PLoS One 2017; 12(4): e0175456.
[] [PMID: 28406949]
Deutscher M, Lewis M, Zell ER, Taylor TH Jr, Van Beneden C, Schrag S. Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women. Clin Infect Dis 2011; 53(2): 114-23.
[] [PMID: 21690617]
Alexander AJ, Myers C, Beres SB, Olsen RJ, Musser JM, Mangino JE. Postpartum group A streptococcus case series: reach out to infection prevention In: Open forum infectious diseases. UK: Oxford University Press 2018. 5: p. (7)ofy159.
Yildirim G, Güngördük K, Asicioğlu O, et al. Does vaginal preparation with povidone-iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial. J Matern Fetal Neonatal Med 2012; 25(11): 2316-21.
[] [PMID: 22590998]
van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis 2010; 23(3): 249-54.
[] [PMID: 20375891]
Avelar JB, Silva MGD, Rezende HHA, et al. Epidemiological factors associated with Toxoplasma gondii infection in postpartum women treated in the public healthcare system of Goiânia, State of Goiás, Brazil. Rev Soc Bras Med Trop 2018; 51(1): 57-62.
[] [PMID: 29513843]
Moradi Z. Evaluation of wound complications after cesarean section and its related factors in women referring to Vali-e-Asr hospital FASA 1394. J Fasa Univ Med Sci 2018; 8(1): 701-7.
Alizadeh P. Investigation of the relation between pathogens in the surgeon and surgeon assistant hands and surgery site, and organisms in the wound infection site in patients that had cesarean in Rasool-Akram and Akbar-Abadi Hospitals and returned with post-cesarean section wound infection. Majallah-i Ulum-i Pizishki-i Razi 2016; 23(147): 1-10.
Masoumi Z, Keramat A, Hajiaghaee R. Systematic review on effect of herbal medicine on pain after perineal episiotomy and cesarean cutting. Faslnamah-i Giyahan-i Daruyi 2011; 4(40): 1-16.
Ghasemi E, Mansouri S, Shahabinejad N. Vaginal colonization and susceptibility to antibiotics of Enterococci during late pregnancy in Kerman City, Iran. Arch Clin Infect Dis 2016; 11(4)
Chan GJ, Baqui AH, Modak JK, et al. Early-onset neonatal sepsis in Dhaka, Bangladesh: risk associated with maternal bacterial colonisation and chorioamnionitis. Trop Med Int Health 2013; 18(9): 1057-64.
[] [PMID: 23822861]
Liu S, Heaman M, Joseph KS, et al. Risk of maternal postpartum readmission associated with mode of delivery. Obstet Gynecol 2005; 105(4): 836-42.
[] [PMID: 15802414]
Dallazen C, Vitolo MR. Excessive maternal weight and practice of exclusive breastfeeding among women of low socioeconomic status. Rev Nutr 2017; 30(1): 69-77.
Mirzayi F, Akbarzadeh M, Mirzayi M. Evaluation of maternal, fetal and neonatal complications according to body mass index in women referred to Shiraz health choice centers, 2009. Majallah-i Zanan, Mamai va Nazai-i Iran 2012; 14(8): 25-33.
Bonet M, Ota E, Chibueze CE, Oladapo OT. Antibiotic prophylaxis for episiotomy repair following vaginal birth. Cochrane Database Syst Rev 2017; 11(11): CD012136.
[] [PMID: 29096053]
Navali N. Comparison between preventive antibiotic regimes of cefazolin with or without Azithromycin in cesarean surgical site infection. Majallah-i pizishki-i Danishgah-i Ulum-i Pizishki va Khadamat- i Bihdashti-i Darmani-i Tabriz 2018; 40(1): 77-83.
Asghania M, Mirblouk F, Shakiba M, Faraji R. Preoperative vaginal preparation with povidone-iodine on post-caesarean infectious morbidity. J Obstet Gynaecol 2011; 31(5): 400-3.
[] [PMID: 21627422]
Haas DM, Morgan S, Contreras K, Kimball S. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev 2020; 4(4): CD007892.
[] [PMID: 32335895]

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