Postpartum Endometritis

Aka: Postpartum Endometritis, Postpartum Endomyometritis, 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