Vol.74 No.5 September 2026
Incidence of puerperal fever following discontinuation of prophylactic antimicrobials after vaginal delivery: an observational survey
1)Department of Pharmacy, Koyama Memorial Hospital, 5-1-2 Kuriya, Kashima city, Ibaraki, Japan
2)Department of Obstetrics and Gynecology, Koyama Memorial Hospital
Abstract
Perinatal infections remain a leading cause of maternal mortality and are associated with long-term sequelae such as chronic pelvic pain and infertility. Cesarean delivery carries a higher risk of wound and pelvic infections; therefore, preoperative antimicrobial prophylaxis is recommended. In contrast, the risk of infection following vaginal delivery is relatively low, and international guidelines do not recommend the routine use of antimicrobials in this setting. Nevertheless, in Japan, prophylactic antimicrobials are still frequently initiated following vaginal delivery, and the appropriateness of this practice has been questioned.
At our institution, all women undergoing vaginal delivery previously received routine antimicrobial prophylaxis with cefcapene pivoxil, an oral third-generation cephalosporin, for five days. We discontinued this practice, and in this retrospective study, we investigated the incidence of puerperal fever after vaginal delivery following discontinuation of the practice using electronic medical records. We also examined the occurrence of fever up to the end of the two routine postpartum visits at two weeks and one month.
No cases of puerperal fever or other febrile episodes were observed during hospitalization or up to the second postpartum follow-up visit at the end of one month, even among women in whom various microorganisms were detected in vaginal secretions.
These findings suggest that prophylactic antimicrobials may not be essential for preventing postpartum infectious morbidity after vaginal delivery, likely because natural host defenses, such as mucosal immunity and the resident microbiota, remain intact. Furthermore, since antimicrobial exposure can interfere with the establishment of the neonatal gut microbiome, the routine use of prophylactic antimicrobials in low-risk women after vaginal delivery should be reconsidered. This study provides practical evidence supporting a more selective approach to antimicrobial use in the postpartum period, which could contribute to improved quality of perinatal care.
Key word
antimicrobial prophylaxis, antimicrobial resistance, perinatal infection, puerperal endometritis, puerperal fever
Received
November 12, 2025
Accepted
May 7, 2026
Jpn. J. Chemother. 74 (5): 531-537, 2026
