ID

Postpartum Endometritis

search

Postpartum Endometritis, Postpartum Endomyometritis

  • See Also
  • 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)
  • Epidemiology
  1. Onset postpartum (days 5 to 21 after delivery)
  • Pathophysiology
  1. Polymicrobial material into amniotic fluid
  • 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
  • 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
  • Differential Diagnosis
  • Seven W's of maternal fever
  • Imaging
  1. Chest XRay
  2. Pelvic Ultrasound when indicated
  3. CT Abdomen and Pelvis
    1. Changes management in up to 40% of cases
  • 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
  • References
  1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4