Today we assume that puerperal fever is part of history, but the sad fact is that women still get it, and a small number lose their lives

It turned maternity wards into morgues, but today few pregnant women have even heard of puerperal fever, an aggressive infection of the reproductive system following childbirth. It probably changed the course of English history by killing Jane Seymour, third wife of Henry VIII. It destroyed Isabella Beeton and ruined her husband's life and business. It finished off proto-feminist Mary Wollstonecraft, leaving Mary Shelley motherless.

In the 1700s, when it was known as childbed fever, puerperal fever could claim the lives of as many as 20 per cent of new mothers and would sweep through communities in terrifying epidemics. The infection - most commonly the bacteria staphylococcus and streptococcus - was often carried on the dirty hands and medical instruments of doctors and midwives.

Still here today
The Department of Health, in its report 'Why Mothers Die,' showed that 16 women died of puerperal fever between 1994 and 1996. The authors conclude that it 'is not a disease of the past, and GPs and midwives must be aware of the signs and be prepared to institute immediate treatment.'

'I have seen one death from it,' says Dr Gabrielle Downey, a consultant obstetrician at City Hospital, Birmingham. 'The woman came in literally navy blue and was dead within the hour. If the patient gets overwhelming sepsis, the essential organs shut down - but deaths these days are very rare.'

However, around 50,000 new mums are affected each year by group B streptococcus, which usually lives harmlessly in the vagina or intestines of 10-35 per cent of healthy women. It is one of the commonest bacteria involved in puerperal fever and infection occurs up to two weeks after childbirth or abortion. Typically it is the uterus that is infected, but injuries to any part of the genital tract can provide a breeding ground.

A fever after childbirth might not always be caused by an infection of the genital tract. Breast, urinary and wound infections are also a possibility. Alternatively, a woman may simply have the flu.

Thanks be to Dr Semmelweiz
Pregnant women today need to thank the Hungarian doctor Ignaz Semmelweiz for their health. The role of bacteria in infection wasn't recognised until the end of the 19th century, but in the 1840s Dr Semmelweiz observed that childbed fever was carried on the hands of birth attendants. Although his theory was hugely controversial, he insisted that they scrub their hands in chloride of lime. The death rate plummeted as a result.

Doctors of this generation would rarely have encountered a case of puerperal sepsis - the deadly phase of the disease - but Dr Downey reassures us that they have been sufficiently trained to cope. Early administration of antibiotics is the recommended treatment.

Do we need screening?
However, Dr Downey does believe that we might not be sufficiently screening pregnant women for group B streptococcus. 'Nobody knows what is the best thing to do,' she says. 'Should we take a swab from every pregnant woman, and if we do, how often, and what should we do as a result of it?'

In her own hospital, Dr Downey screens all women who have had a problem in the past with group B strep on a monthly basis. Antibiotics are administered during labour as a precautionary measure. Although there are currently no national guidelines on screening for group B strep, the Public Health Laboratory Service GBS Working Group has issued "interim good practice recommendations for the prevention of early-onset GBS infection in the UK" click here to download their factsheet.

Are you vulnerable?
Are some women more prone to puerperal fever? Those who are run down and anaemic or have endured a long labour may be more vulnerable, as are those who are HIV positive or have other conditions or drug treatments that compromise their immune system. Women who have Caesareans may get localised wound infections but, Dr Downey says, they are no more likely get puerperal sepsis.

The charity Group B Strep Support recommends that women in known higher risk categories are offered intravenous antibitoics from the onset of labour through until delivery. Doing this prevents many babies needlessly suffering GBS infections and also prevents most of the deaths from these infections in newborn babies. In almost all cases, antibiotics are able to nip infection in the bud. It is estimated that, in the Western world, only three women in 100,000 births die from puerperal infection. Women in developing countries are not so lucky: it is thought the death rate there may be 100 times higher.

Symptoms of puerperal fever
Symptoms include:

• Fever over 100°F (38°C) in the first two weeks after delivery
• Chills, headache, lack of appetite and generally feeling unwell
• The flow of blood and mucus from the uterus, called lochia, might increase or decrease, and can smell offensive

Abdominal pain
If you are experiencing any of these symptoms following the birth of your baby it is vital you seek medical attention quickly. It may be just the flu, or something else completely unrelated to pregnancy, but if it is puerperal fever, antibiotic treatment needs to be started as soon as possible.

And baby too
The life of a baby delivered by a mother with 'group B strep' is also at risk. It is the most common cause of life threatening infections in babies up to three months in the UK, infects 700 babies each year, of which 100 sadly die.

'In a small number it can cause infection in the baby,' says Dr Downey. Babies more at risk are those who are born prematurely, those where the membrane ruptured 18-24 hours before delivery, and those where the mother had a temperature during delivery.

For more information visit Group B Strep Support at www.gbss.org.uk