Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-23T04:09:49.577Z Has data issue: false hasContentIssue false

Chapter 70 - Puerperal Problems (Content last reviewed: 20th February 2020)

from Section 7 - Postnatal Problems

Published online by Cambridge University Press:  15 November 2017

By
Tan Thiam Chye  and
Shephali Tagore
Edited by
David James ,
Philip Steer ,
Carl Weiner ,
Bernard Gonik  and
Stephen Robson
David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

Most women experience an uncomplicated postpartum period, with the majority of the physiological changes of pregnancy having resolved by 6 weeks. However, some women may develop serious complications during this time, and understanding the physiological and emotional process of recovery after birth is essential to allow prompt recognition of puerperal problems and timely action.

Type
Chapter
Information
High-Risk Pregnancy
Management Options
 , pp. 1965 - 1984
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

National Institute for Health and Care Excellence. Postnatal Care up to 8 Weeks after Birth. NICE Clinical Guideline CG37. London: NICE, 2006. https://www.nice.org.uk/guidance/cg37 (accessed March 2017).Google Scholar
Li, XF, Fortney, JA, Kotelchuck, M, Glover, LH. The postpartum period: the key to maternal mortality. Int J Gynaecol Obstet 1996; 54: 1–10.Google Scholar
World Health Organization. WHO Recommendations on Postnatal Care of the Mother and Newborn. Geneva: WHO, 2013. http://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ (accessed March 2017).Google Scholar
Attrill, B. The assumption of the maternal role: a developmental process. Aust J Midwifery 2002; 15: 21–5.Google Scholar
Sherman, D, Lurie, S, Frenkel, E, et al. Characteristics of normal lochia. Am J Perinatol 1999; 16: 399–402.CrossRefGoogle ScholarPubMed
Chi, C, Bapir, M, Lee, CA, Kadir, RA. Puerperal loss (lochia) in women with or without inherited bleeding disorders. Am J Obstet Gynecol 2010; 203: 56.e1–5.Google Scholar
Oppenheimer, LW, Sherriff, EA, Goodman, JD, Shah, D, James, CE. The duration of lochia. Br J Obstet Gynaecol 1986; 93: 754–7.Google Scholar
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin Number 76: Postpartum hemorrhage. Obstet Gynecol 2006; 108: 1039–47.Google Scholar
Royal College of Obstetricians and Gynaecologists. Prevention and Management of Postpartum Haemorrhage, 2nd edn. Green-top Guideline No. 52. London: RCOG, 2016. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg52 (accessed March 2017).Google Scholar
Hoveyda, F, MacKenzie, IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG 2001; 108: 927–30.Google Scholar
Alexander, J, Thomas, P, Sanghera, J. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev 2002; (1): CD002867.Google Scholar
King, PA, Duthie, SJ, Dong, ZG, Ma, HK. Secondary postpartum haemorrhage. Aust N Z J Obstet Gynaecol 1989; 29: 394–8.Google Scholar
Cunningham, FG, Leveno, KJ, Bloom, SL, et al. Williams Obstetrics, 23rd edn. New York, NY: McGraw-Hill, 2010.Google Scholar
Ahmed, B, Abu Nahia, F, Abushama, M. Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study. J Perinat Med 2005; 33: 510–13.Google Scholar
Longo, LD. Classic pages in obstetrics and gynecology. Regeneration of the uterine mucosa after delivery, with special reference to the placental site: John Whitridge Williams, Americal Journal of Obstetrics and Gynecology, vol. 22, pp. 664–696 and 793–796, 1931. Am J Obstet Gynecol 1979; 134: 715–16.Google Scholar
Garmi, G, Salim, R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int 2012; 2012: 873929.Google Scholar
Sentilhes, L, Ambroselli, C, Kayem, G, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010; 115: 526–34.CrossRefGoogle ScholarPubMed
Neill, A, Thornton, S. Secondary postpartum haemorrhage. J Obstet Gynaecol 2002; 22: 119–22.Google Scholar
Lewis, G (ed.). The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer – 2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH, 2007.Google Scholar
Liabsuetrakul, T, Choobun, T, Peeyananjarassri, K, Islam, QM. Prophylactic use of ergot alkaloids in the third stage of labour. Cochrane Database Syst Rev 2007; (2): CD005456.Google Scholar
Rath, W. Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin. Eur J Obstet Gynecol Reprod Biol 2009; 147: 15–20.CrossRefGoogle ScholarPubMed
French, LM, Smaill, FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev 2004; (4): CD001067.Google Scholar
Edwards, A, Ellwood, DA. Ultrasonographic evaluation of the postpartum uterus. Ultrasound Obstet Gynecol 2000; 16: 640–3.Google Scholar
James, AH. Von Willebrand disease. Obstet Gynecol Surv 2006; 61: 136–45.Google Scholar
Condous, GS, Arulkumaran, S, Symonds, I, et al. The “tamponade test” in the management of massive postpartum hemorrhage. Obstet Gynecol 2003; 101: 767–72.Google Scholar
Bakri, YN, Amri, A, Abdul Jabbar, F. Tamponade-balloon for obstetrical bleeding. Int J Gynaecol Obstet 2001; 74: 139–42.Google Scholar
Georgiou, C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009; 116: 748–57.Google Scholar
Hunter, LA. Exploring the role of uterine artery embolization in the management of postpartum hemorrhage. J Perinat Neonatal Nurs 2010; 24: 207–14.Google ScholarPubMed
Ganguli, S, Stecker, MS, Pyne, D, Baum, RA, Fan, CM. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol 2011; 22: 169–76.CrossRefGoogle ScholarPubMed
Li, X, Wang, Z, Chen, J, et al. Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clin Radiol 2012; 67: e71–6.CrossRefGoogle ScholarPubMed
Franchini, M, Franchi, M, Bergamini, V, et al. The use of recombinant activated FVII in postpartum hemorrhage. Clin Obstet Gynecol 2010; 53: 219–27.Google Scholar
Yokoe, DS, Christiansen, CL, Johnson, R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001; 7: 837–41.Google Scholar
Hamadeh, G, Dedmon, C, Mozley, PD. Postpartum fever. Am Fam Physician 1995; 52: 531–8.Google ScholarPubMed
Mason, KL, Aronoff, DM. Postpartum group A Streptococcus sepsis and maternal immunology. Am J Reprod Immunol 2012; 67: 91–100.Google Scholar
Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002; 35: 950–9.Google Scholar
Sebastian, F, Monif, GRG, Baker, DA. Infectious Diseases in Obstetrics and Gynecology, 6th edn. Boca Raton, FL: CRC Press, 2008.Google Scholar
Khan, KS, Wojdyla, D, Say, L, Gulmezoglu, AM, Van Look, PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066–74.Google Scholar
Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–55.Google Scholar
Stefonek, KR, Maerz, LL, Nielsen, MP, Besser, RE, Cieslak, PR. Group A streptococcal puerperal sepsis preceded by positive surveillance cultures. Obstet Gynecol 2001; 98: 846–8.Google Scholar
Barnham, MR, Weightman, NC. Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important. J Infect 2001; 43: 173–6.Google Scholar
Locksmith, GJ, Duff, P. Assessment of the value of routine blood cultures in the evaluation and treatment of patients with chorioamnionitis. Infect Dis Obstet Gynecol 1994; 2: 111–14.Google Scholar
Garcia, J, Aboujaoude, R, Apuzzio, J, Alvarez, JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2006; 2006: 15614.Google Scholar
Dinsmoor, MJ, Newton, ER, Gibbs, RS. A randomized, double-blind, placebo-controlled trial of oral antibiotic therapy following intravenous antibiotic therapy for postpartum endometritis. Obstet Gynecol 1991; 77: 60–2.Google Scholar
Rhodes, A, Evans, LE, Alhazzani, W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304–77.Google Scholar
Kankuri, E, Kurki, T, Carlson, P, Hiilesmaa, V. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand 2003; 82: 730–5.Google Scholar
Duff, P. Antibiotic selection in obstetrics: making cost-effective choices. Clin Obstet Gynecol 2002 ;45: 59–72.Google Scholar
Herman, G, Cohen, AW, Talbot, GH, et al. Cefoxitin versus clindamycin and gentamicin in the treatment of postcesarean section infections. Obstet Gynecol 1986; 67: 371–6.Google Scholar
Witlin, AG, Mercer, BM, Sibai, BM. Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology. J Matern Fetal Med 1996; 5: 355–8.Google ScholarPubMed
Duff, P, Gibbs, RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv 1983; 38: 365–73.Google Scholar
Witlin, AG, Sibai, BM. Postpartum ovarian vein thrombosis after vaginal delivery: a report of 11 cases. Obstet Gynecol 1995; 85: 775–80.Google Scholar
Dessole, S, Capobianco, G, Arru, A, Demurtas, P, Ambrosini, G. Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature. Arch Gynecol Obstet 2003; 267: 242–6.Google Scholar
Dunnihoo, DR, Gallaspy, JW, Wise, RB, Otterson, WN. Postpartum ovarian vein thrombophlebitis: a review. Obstet Gynecol Surv 1991; 46: 415–27.Google Scholar
Savader, SJ, Otero, RR, Savader, BL. Puerperal ovarian vein thrombosis: evaluation with CT, US, and MR imaging. Radiology 1988; 167: 637–9.Google Scholar
Martin, B, Mulopulos, GP, Bryan, PJ. MRI of puerperal ovarian-vein thrombosis (case report). AJR Am J Roentgenol 1986; 147: 291–2.Google Scholar
Duff, P. Maternal and perinatal infection. In Gabbe, SG, Niebyl, JR, Simpson, JL (eds), Obstetrics: Normal and Problem Pregnancies, 4th edn. New York, NY: Churchill Livingstone, 2002, p. 16.Google Scholar
Johnson, SC, Esclapes, M. Sonography of postpartum ovarian vein thrombophlebitis. J Clin Ultrasound 1998; 26: 143–9.Google Scholar
Brown, CE, Dunn, DH, Harrell, R, Setiawan, H, Cunningham, FG. Computed tomography for evaluation of puerperal infections. Surg Gynecol Obstet 1991; 172: 285–9.Google Scholar
Brown, CE, Stettler, RW, Twickler, D, Cunningham, FG. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181: 143–8.Google Scholar
Chen, KC. Septic pelvic thrombophlebitis. UpToDate 2016. http://www.uptodate.com/contents/septic-pelvic-thrombophlebitis (accessed March 2017).Google Scholar
Hoddinott, P, Tappin, D, Wright, C. Breast feeding. BMJ 2008; 336: 881–7.Google Scholar
Quigley, MA, Kelly, YJ, Sacker, A. Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics 2007; 119: e837–42.Google Scholar
Kramer, MS, Kakuma, R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012; (8): CD003517.Google Scholar
Bolling, K, Grant, C, Hamlyn, B, Thornton, A. Infant Feeding Survey 2005. London: The Information Centre, 2007.Google Scholar
Centers for Disease Control and Prevention. Breastfeeding report card 2016. Atlanta, GA: CDC, 2016. https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf (accessed March 2017).Google Scholar
Livingstone, V. Too much of a good thing. Maternal and infant hyperlactation syndromes. Can Fam Physician 1996; 42: 89–99.Google Scholar
World Health Organization. Mastitis: Causes and Management. Geneva: WHO, 2000.Google Scholar
Betzold, CM. An update on the recognition and management of lactational breast inflammation. J Midwifery Womens Health 2007; 52: 595–605.Google Scholar
Abou-Dakn, M, Richardt, A, Schaefer-Graf, U, Wockel, A. Inflammatory breast diseases during lactation: milk stasis, puerperal mastitis, abscesses of the breast, and malignant tumors. Current and evidence-based strategies for diagnosis and therapy. Breast Care 2010; 5: 33–7.CrossRefGoogle ScholarPubMed
Mangesi, L, Zakarija-Grkovic, I. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev 2016; (6): CD006946.Google Scholar
Bell, H, Peters, G, Lynch, A, Harle, R. Breast disorders during pregnancy and lactation: the differential diagnoses. J Clin Gynecol Obstet 2013; 2: 47–50.Google Scholar
Sabate, JM, Clotet, M, Torrubia, S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics 2007; 27 (Suppl 1): S101–24.Google Scholar
Yu, JH, Kim, MJ, Cho, H, et al. Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56: 143–59.Google Scholar
Tan, TC, Tan, KT, Tay, EH, Chonkar, S. Lactation and breastfeeding. In Practical Obstetrics and Gynaecology Handbook for O&G Clinicians and General Practitioners, 2nd edn. Singapore: World Scientific, 2014, pp. 243–52.Google Scholar
Cizmeci, MN, Kanburoglu, MK, Akelma, AZ, Tatli, MM. Rusty-pipe syndrome: a rare cause of change in the color of breastmilk. Breastfeed Med 2013; 8: 340–1.Google Scholar
Taylor, D, Lazberger, J, Ives, A, Wylie, E, Saunders, C. Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us. J Med Imaging Radiat Oncol 2011; 55: 33–42.Google Scholar
Ayyappan, AP, Kulkarni, S, Crystal, P. Pregnancy-associated breast cancer: spectrum of imaging appearances. Br J Radiol 2010; 83: 529–34.Google Scholar
Groer, MW, Davis, MW. Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders. J Obstet Gynecol Neonatal Nurs 2006; 35: 599–607.Google Scholar
Jones, I, Chandra, PS, Dazzan, P, Howard, LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 2014; 384: 1789–99.Google Scholar
Boland, BF. Rupture of the symphysis pubis articulation during delivery. Surg Gynecol Obstet 1933; 57: 517–22.Google Scholar
Scriven, MW, Jones, DA, McKnight, L. The importance of pubic pain following childbirth: a clinical and ultrasonographic study of diastasis of the pubic symphysis. J Roy Soc Med 1995; 88: 28–30.Google ScholarPubMed
Pennig, D, Gladbach, B, Majchrowski, W. Disruption of the pelvic ring during spontaneous childbirth: a case report. J Bone Joint Surg Br 1997; 79: 438–40.Google Scholar
Kharrazi, FD, Rodgers, WB, Kennedy, JG, Lhowe, DW. Parturition-induced pelvic dislocation: a report of four cases. J Orthop Trauma 1997; 11: 277–81.Google Scholar
Putschar, WG. The structure of the human symphysis pubis with special consideration of parturition and its sequelae. Am J Phys Anthropol 1976; 45: 589–94.Google Scholar
Hou, Z, Riehl, JT, Smith, WR, Strohecker, KA, Maloney, PJ. Severe postpartum disruption of the pelvic ring: report of two cases and review of the literature. Patient Saf Surg 2011; 5 (1): 2.Google Scholar
Hagen, R. Pelvic girdle relaxation from an orthopaedic point of view. Acta Orthop Scand 1974; 45: 550–63.Google Scholar
Cole, JT. Maternal obstetric paralysis. Am J Obstet Gynecol 1946; 52: 372–86.Google Scholar
Bradley, WG (ed.). Neurology in Clinical Practice. Philadelphia, PA: Butterworth Heinemann, 2004.Google Scholar
Glavind, K, Bjork, J. Incidence and treatment of urinary retention postpartum. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14: 119–21.Google Scholar
Kearney, R, Cutner, A. Postpartum voiding dysfunction. Obstetrician & Gynaecologist 2008; 10: 71–4.CrossRefGoogle Scholar
Ching-Chung, L, Shuenn-Dhy, C, Ling-Hong, T, et al. Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Aust N Z J Obstet Gynaecol 2002; 42: 365–8.Google Scholar
MacLean, AB, Cardozo, L. Incontinence in Women: the Findings of the 42nd RCOG Study Group. London: RCOG, 2002.Google Scholar
Penney, G, Brechin, S, Allerton, L; Clinical Effectiveness Unit (CEU) of the Faculty of Family Planning and Reproductive Health Care (FFPRHC), Royal College of Obstetricians and Gynaecologists. FFPRHC Guidance (July 2005): the use of contraception outside the terms of the product licence. J Fam Plann Reprod Health Care 2005; 31: 225–41.Google Scholar
Faculty of Sexual and Reproductive Healthcare. CEU Clinical Guidance: Contraception After Pregnancy. London: FSRH, 2017. https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-guideline-january-2017 (accessed March 2017).Google Scholar
Barrett, G, Pendry, E, Peacock, J, et al. Women’s sexual health after childbirth. BJOG 2000; 107: 186–95.Google Scholar
von Sydow, K. Sexuality during pregnancy and after childbirth: a metacontent analysis of 59 studies. J Psychosom Res 1999; 47: 27–49.Google Scholar
Trussell, J. Contraceptive failure in the United States. Contraception 2011; 83: 397–404.Google Scholar
Faculty of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for Contraceptive Use: UKMEC 2016. London: FSRH, 2016.Google Scholar
Labbok, MH, Hight-Laukaran, V, Peterson, AE, et al. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55: 327–36.Google Scholar
Ingram, J, Hunt, L, Woolridge, M, Greenwood, R. The association of progesterone, infant formula use and pacifier use with the return of menstruation in breastfeeding women: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2004; 114: 197–202.Google Scholar
Li, W, Qiu, Y. Relation of supplementary feeding to resumptions of menstruation and ovulation in lactating postpartum women. Chin Med J 2007; 120: 868–70.Google Scholar
Truitt, ST, Fraser, AB, Grimes, DA, Gallo, MF, Schulz, KF. Hormonal contraception during lactation: systematic review of randomized controlled trials. Contraception 2003; 68: 233–8.Google Scholar
Truitt, ST, Fraser, AB, Grimes, DA, Gallo, MF, Schulz, KF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev 2003; (2): CD003988.Google Scholar
Grimes, DA, Lopez, LM, Schulz, KF, Van Vliet, HA, Stanwood, NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev 2010; (5): CD003036.Google Scholar
Eroglu, K, Akkuzu, G, Vural, G, et al. Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up. Contraception 2006; 74: 376–81.Google Scholar
Faculty of Sexual and Reproductive Healthcare. Male and Female Sterilisation Summary of Recommendations: Clinical Guidance. London: FSRH, 2014. https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-sterilisation-cpd-sep-2014/ (accessed March 2017).Google Scholar
Peterson, HB, Xia, Z, Hughes, JM, et al. The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 1997; 336: 762–7.Google Scholar
Westhoff, C, Davis, A. Tubal sterilization: focus on the U.S. experience. Fertil Steril 2000; 73: 913–22.Google Scholar
Gentile, GP, Kaufman, SC, Helbig, DW. Is there any evidence for a post-tubal sterilization syndrome? Fertil Steril 1998;69(2):179–86.Google Scholar
Peterson, HB, Jeng, G, Folger, SG, et al. The risk of menstrual abnormalities after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 2000; 343: 1681–7.Google Scholar
Irwin, KL, Weiss, NS, Lee, NC, Peterson, HB. Tubal sterilization, hysterectomy, and the subsequent occurrence of epithelial ovarian cancer. Am J Epidemiol 1991; 134: 362–9.Google Scholar
Rosenblatt, KA, Thomas, DB. Reduced risk of ovarian cancer in women with a tubal ligation or hysterectomy. The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Cancer Epidemiol Biomarkers Prev 1996; 5: 933–5.Google Scholar
Abbuhl, SB, Muskin, EB, Shofer, FS. Pelvic inflammatory disease in patients with bilateral tubal ligation. Am J Emerg Med 1997; 15:271–4.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×