Th e majority of infections occur postpartum; 'puerpural sepsis' or 'puerperal fever' is an umbrella term for a variety of infections that occur in the puerperium. Th e leading risk factor for puerpural sepsis is Cesarean delivery. Other signifi cant risk factors include retained products of conception, episiotomy, and prolonged rupture of the amniotic membranes. Infection may involve endometritis, parametritis (spread through the uterine wall), peritonitis, or thrombophlebitis of the pelvic veins. Endometritis is most commonly associated with group A streptococcal (GAS) infection, although Staphylococus, coliform, and anerobes may also be present. Hand washing and disinfectants dramatically decreased the incidence of puerperal fever. Pre-emptive antibiotics are administered if prolonged rupture of the membranes has occurred, to treat amnionitis, or if the woman has a fever and a foul-smelling vaginal discharge.