Postpartum Endometritis

Aka: Postpartum Endometritis, Postpartum Endomyometritis

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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

  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")

VIII. Labs

  1. Complete Blood Count
  2. Urinalysis
  3. Urine Culture
  4. Blood Culture

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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Related Studies (from Trip Database) Open in New Window

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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