II. 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)

III. Epidemiology

  1. Onset postpartum (days 5 to 21 after delivery)

IV. Pathophysiology

  1. Polymicrobial material into amniotic fluid

V. 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

VI. 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

VII. Differential Diagnosis: Seven W's of maternal fever

IX. Imaging

  1. Chest XRay
  2. Pelvic Ultrasound when indicated
  3. CT Abdomen and Pelvis
    1. Changes management in up to 40% of cases

X. 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

XI. References

  1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4

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Ontology: 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

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, 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