Postpartum endometritis

For endometritis unrelated to pregnancy, see Pelvic inflammatory disease (PID).

Background[1]

  • Any postpartum woman with fever should be assumed to have a genital tract infection
  • Postpartum women have a 20-fold increase in invasive group A streptococcal infection compared with nonpregnant women.
  • Most often polymicrobial, requiring broad spectrum antibiotics
  • Maternal mortality is highest if infection develops within 4 days of delivery

Risk Factors

  • Cesarean delivery (most important)
  • Prolonged labor
  • Prolonged or premature rupture of membranes
  • Internal fetal or uterine monitoring
  • Large amount of meconium in amniotic fluid
  • Manual removal of placenta
  • Diabetes Mellitus
  • Preterm birth
  • Bacterial vaginosis
  • Operative vaginal delivery
  • Post-term pregnancy
  • HIV infection
  • Colonization with Group B Strep

Clinical Features

  • Fever
  • Foul-smelling lochia
  • Leukocytosis
  • Uterine tenderness
  • Only scant discharge may be present (esp with group B strep)

Differential Diagnosis

  • Respiratory tract infection
  • UTI/urosepsis
  • Pyelonephritis
  • Intra-abdominal abscess
  • Thrombophlebitis

3rd Trimester/Postpartum Emergencies

Evaluation

Management

<48hrs Post Partum

Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora

>48hrs Post Partum

Disposition

  • Consult OB/GYN first if are considering outpatient management
  • Admit all patients who appear ill, have had a C-section, or underlying comorbid conditions

See Also

  • Post-Partum Emergencies

References

  1. Stevens DL and Bryant A. Pregnancy-related group A streptococcal infection.
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