Obstetrics Book

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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 seeded from vaginal flora
    2. Contiguous infection spread to myometrium and Pelvis
  5. Risk Factors
    1. Cesarean Section
    2. Intrauterine instrumentation (e.g. manual placental removal)
    3. Prolonged Rupture of Membranes
    4. Vaginal infections and colonization (e.g. Bacterial Vaginosis, Group B Streptococcus)
  6. 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
      2. Gram Negative Bacteria (e.g. Escherichia coli)
      3. Anaerobic Bacteria (e.g. Bacteroides, Clostridium, Peptostreptococci)
      4. Staphylococcus aureus is uncommon in Postpartum Endometritis
    3. Chlamydia
      1. Most common organism after 2-3 weeks postpartum
    4. HIV Positive related causes
      1. Herpes Simplex Virus
      2. Cytomegalovirus
  7. Symptoms
    1. Fever
    2. Lower midline Abdominal Pain
    3. Purulent Vaginal Discharge
  8. Signs
    1. Maternal Fever
      1. Temperature > 38.0 C (100.4 F)
        1. Two separate recorded values
        2. Occurs >24 hours Postpartum and within first 10 post-partum days
      2. Temperature > 38.7 C (101.5 F)
    2. General physical examination
      1. See Postpartum Fever
      2. Sinus Tachycardia
    3. Pelvic examination
      1. Vaginal hematoma
      2. Lochia blockage
      3. Foul lochia
  9. Differential Diagnosis
    1. See Maternal Fever
  10. Labs
    1. Complete Blood Count
    2. Urinalysis
    3. Urine Culture
    4. Blood Culture
  11. Imaging
    1. Chest XRay
    2. Pelvic Ultrasound when indicated
    3. CT Abdomen and Pelvis
      1. Changes management in up to 40% of cases
  12. 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
      4. Consider infected retained products of conception
  13. Complications
    1. See Pelvic Vein Thrombophlebitis
  14. References
    1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4
    2. Dalton (2014) Obstet Med 7(3): 98–102 +PMID:27512432 [PubMed]
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934978/

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
Sources
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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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