Table Of Contents
Endometritis
Endometritis is an ascending polymicrobial infection of the uterine lining, which may progress to invade the underlying wall (endomyometritis). It is the most common cause of postpartum fever. It is more common after caesarean delivery, but can occur after vaginal delivery especially following manual delivery of the placenta. The common sites of infection are the implantation site or incision site.
The most common cause of early onset endometritis is Group B streptococcus. A common cause of late onset endometritis is chlamydia spp.
Definition of terms
| Term | Definition |
|---|---|
| Early postpartum endometritis | Onset < 48 hours. Usually after caesarean delivery |
| Late postpartum endometritis | Onset 48 hours to 6 weeks. Usually after vaginal delivery |
- Risk factors for endometritis
- Caesarean delivery
- Manual removal of the placent
- Prolonged labor (higher risk for endometritis and chorioamnionitis since more vaginal exams are done)
- Number of cervical exams
- Immunosuppression (HIV+)
- GBS positive
- Adolescent
- Chlamydia infection
- Patient history
- Caesarean delivery
- Manual removal of the placenta after vaginal delivery
- Signs and symptoms
- Fever
- Tachycardia
- Foul smelling lochia
- Pelvic tenderness (exquisite uterine tenderness that has gotten worse)
- Investigations
- Pelvic ultrasound: rule out retained products of conception
- Complete blood count:
- Elevated WBC with left shift
- U/E/Cs:
- Hyponatremia in sepsis
- Urinalysis and culture: to rule out UTI
- Blood culture: variable
- Chest X-ray: unremarkable
- Treatment
- Admit
- Clindamycin + gentamicin.
- May transition to PO doxycycline after being afebrile for 24-48 hours for 11-14 days (advice not to breastfeed while taking doxycycline)
- Ultrasound-guided D&C to remove RPOCs
- Serial complete blood count for WBC for normalization
- Complications of endometritis
- Sepsis
- Peritonitis
- Pelvic abscess
- Hematoma
- Septic pelvic thrombophlebitis
