Obstetrics Book


Postpartum Endometritis

Aka: Postpartum Endometritis, Postpartum Endomyometritis
  1. See Also
    1. Endometritis
  2. Definition
    1. Postpartum Endometritis
      1. Postpartum uterine infection of the endometrial cavity
    2. Endomyometritis
      1. Uterine infection of the endometrial cavity and the uterine wall (typically after Cesarean Section)
  3. Epidemiology
    1. Onset postpartum (days 5 to 21 after delivery)
  4. Pathophysiology
    1. Polymicrobial material into amniotic fluid
  5. Causes
    1. Group B Streptococcus
      1. Most common organism in the first 24 hours postpartum
    2. Mixed anaerobic and aerobic Bacteria
      1. Most common organisms at 3-7 days postpartum
    3. Chlamydia
      1. Most common organism starting 2-3 weeks postpartum
  6. Signs
    1. Maternal fever
      1. Temperature > 38.0 C (100.4 F)
        1. Two separate recorded values
        2. Occurs >24 hours Postpartum
      2. Temperature > 38.7 C (101.5 F)
    2. General physical examination
      1. See Differential Diagnosis
      2. Sinus Tachycardia
    3. Pelvic examination
      1. Vaginal hematoma
      2. Lochia blockage
      3. Foul lochia
  7. Differential Diagnosis: Seven W's of maternal fever
    1. Womb
      1. Endometritis
    2. Wind
      1. Atelectasis
      2. Pneumonia
    3. Water
      1. Urinary Tract Infection
    4. Walk
      1. Deep Vein Thrombosis
      2. Pulmonary Embolism
    5. Wound
      1. Wound Infection
      2. Episiotomy infection
    6. Weaning
      1. Breast engorgement
      2. Mastitis
      3. Breast abscess
    7. Wonder
      1. Drug Fever ("wonder drugs")
  8. Labs
    1. Complete Blood Count
    2. Urinalysis
    3. Urine Culture
    4. Blood Culture
  9. Imaging
    1. Chest XRay
    2. Pelvic Ultrasound when indicated
    3. CT Abdomen and Pelvis
      1. Changes management in up to 40% of cases
  10. Management
    1. Antibiotics
      1. See Endometritis Antibiotic Management
      2. Continue antibiotics until 1-2 days after afebrile
    2. Persistent fever >48 to 72 hours despite antibiotics
      1. Evaluate for pelvic abscess or phlegmon (requires surgical drainage)
      2. Evaluate for septic pelvic Thrombophlebitis
      3. Consider Drug Fever
  11. References
    1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4

Endomyometritis (C0269050)

Definition (MSH) Inflammation of both the ENDOMETRIUM and the MYOMETRIUM, usually caused by infections after a CESAREAN SECTION.
Concepts Disease or Syndrome (T047)
MSH D004716
SnomedCT 198193005, 88027004
English Endomyometritis unspecified, Endomyometritis, endomyometritis, endomyometritis (diagnosis), Endomyometritis unspecified (disorder), Endomyometritis (disorder), Endomyometritis, NOS
Dutch endomyometritis
Spanish Endrometritis, Endomiometritis, endomiometritis, no especificada (trastorno), endomiometritis, no especificada, endomiometritis (trastorno), endomiometritis
Japanese 子宮内膜筋層炎, シキュウナイマクキンソウエン
Czech endomyometritida, Endomyometritida
Portuguese Endomiometrite
French Endomyométrite
German Endomyometritis
Hungarian Endomyometritis
Norwegian Endomyometritt
Italian Endomiometrite
Derived from the NIH UMLS (Unified Medical Language System)

Endometritis postpartum (C0678198)

Definition (NCI) Infection of the endometrium, decidua and/or myometrium occurring at any time between birth and 42 days postpartum.(NICHD)
Concepts Disease or Syndrome (T047)
Dutch endometritis postpartum
French Endométrite du post-partum
German Endometritis, postpartal
Italian Endometrite postpartum
Portuguese Endometrite pós-parto
Spanish Endometritis postparto
Japanese 分娩後子宮内膜炎, ブンベンゴシキュウナイマクエン
Czech Poporodní endometritida
English Endometritis postpartum, endometritis postpartum, postpartum endometritis, Puerperal Endometritis, Postpartum Endometritis
Hungarian Endometritis postpartum
Derived from the NIH UMLS (Unified Medical Language System)

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