Endometritis

Aka: Endometritis, Endomyometritis

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II. Causes

  1. Pelvic Inflammatory Disease
  2. Postpartum
    1. Chorioamnionitis
    2. Endometritis
      1. Early Postpartum (<48 hours) after C-Section
      2. Late Postpartum (48 hours - 6 weeks) after NSVD
  3. Uterine instrumentation
  4. Septic Abortion

III. Pathophysiology

  1. Bacterial Infection of the Uterus
    1. Bacteroides
    2. Group B Streptococcus
    3. Group A Streptococcus
    4. Enterobacteriaceae
    5. Chlamydia trachomatis
    6. M. hominis

IV. Symptoms

  1. Lower abdominal cramps
  2. Foul Vaginal Discharge
  3. Nausea and Vomiting

V. Signs

  1. Fever
  2. Lower abdominal tenderness and Muscle spasm
  3. Cervical motion tenderness

VI. Labs

  1. Complete Blood Count
    1. Leukocytosis
  2. Gram Stain and culture of cervical discharge
  3. Gonorrhea Culture
  4. Chlamydia swab

VII. Management

  1. See Endometritis Management
  2. Inpatient (Indicated in most cases)
    1. Option 1
      1. Cefoxitin OR Timentin OR Imipenem OR Unasyn AND
      2. Doxycycline
    2. Option 2
      1. Clindamycin AND
      2. Ceftriaxone OR Cefotaxime OR Gentamycin
  3. Outpatient (Indicated for late Postpartum Endometritis)
    1. Non-lactating mother
      1. Doxycycline 100 mg q12h IV or PO for 14 days
    2. Lactating mother
      1. Doxycycline
        1. Pump and dispose of milk
      2. Clindamycin may be effective

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