II. 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)
III. Epidemiology
- Onset postpartum (days 5 to 21 after delivery)
IV. Pathophysiology
- Polymicrobial material into amniotic fluid seeded from vaginal flora
- Contiguous infection spread to myometrium and Pelvis
V. 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)
VI. 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
VII. Symptoms
- Fever
- Lower midline Abdominal Pain
- Purulent Vaginal Discharge
VIII. 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)
-
Temperature > 38.0 C (100.4 F)
- General physical examination
- Pelvic examination
- Vaginal hematoma
- Lochia blockage
- Foul lochia
IX. Differential Diagnosis
- See Maternal Fever
XI. Imaging
- Chest XRay
- Pelvic Ultrasound when indicated
-
CT Abdomen and Pelvis
- Changes management in up to 40% of cases
XII. 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
XIII. Complications
XIV. 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]
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Related Studies
| 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 |
Ontology: 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, ﾌﾞﾝﾍﾞﾝｺﾞ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 |
