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Postpartum Endometritis
Aka: Postpartum Endometritis, Postpartum Endomyometritis
- See Also
- Endometritis
- Definition
- Postpartum Endometritis
- Postpartum uterine infection of the endometrial cavity
- Endomyometritis
- Uterine infection of the endometrial cavity and the uterine wall (typically after Cesarean Section)
- Epidemiology
- Onset postpartum (days 5 to 21 after delivery)
- Pathophysiology
- Polymicrobial material into amniotic fluid seeded from vaginal flora
- Contiguous infection spread to myometrium and Pelvis
- Risk Factors
- Cesarean Section
- Intrauterine instrumentation (e.g. manual placental removal)
- Prolonged Rupture of Membranes
- Vaginal infections and colonization (e.g. Bacterial Vaginosis, Group B Streptococcus)
- Causes
- Group B Streptococcus
- Most common organism in the first 24 hours postpartum
- Mixed anaerobic and aerobic Bacteria
- Most common organisms at 3-7 days postpartum
- Gram Negative Bacteria (e.g. Escherichia coli)
- Anaerobic Bacteria (e.g. Bacteroides, Clostridium, Peptostreptococci)
- Staphylococcus aureus is uncommon in Postpartum Endometritis
- Chlamydia
- Most common organism after 2-3 weeks postpartum
- HIV Positive related causes
- Herpes Simplex Virus
- Cytomegalovirus
- Symptoms
- Fever
- Lower midline Abdominal Pain
- Purulent Vaginal Discharge
- Signs
- Maternal Fever
- Temperature > 38.0 C (100.4 F)
- Two separate recorded values
- Occurs >24 hours Postpartum and within first 10 post-partum days
- Temperature > 38.7 C (101.5 F)
- General physical examination
- See Postpartum Fever
- Sinus Tachycardia
- Pelvic examination
- Vaginal hematoma
- Lochia blockage
- Foul lochia
- Differential Diagnosis
- See Maternal Fever
- Labs
- Complete Blood Count
- Urinalysis
- Urine Culture
- Blood Culture
- Imaging
- Chest XRay
- Pelvic Ultrasound when indicated
- CT Abdomen and Pelvis
- Changes management in up to 40% of cases
- Management
- Antibiotics
- See Endometritis Antibiotic Management
- Continue antibiotics until 1-2 days after afebrile
- Persistent fever >48 to 72 hours despite antibiotics
- Evaluate for pelvic abscess or phlegmon (requires surgical drainage)
- Evaluate for Septic Pelvic Thrombophlebitis
- Consider Drug Fever
- Consider infected retained products of conception
- Complications
- See Pelvic Vein Thrombophlebitis
- References
- Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4
- Dalton (2014) Obstet Med 7(3): 98–102 +PMID:27512432 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934978/