Introduction

Postpartum endometritis is a term used to describe inflammation (usually due to infection) in the uterus. It typically due to pregnancy, and can occur up to 6 weeks after delivery. It is more common after caesarian section.

  • There is also a non-pregnancy related type of endometritis – although there is debate as to whether this is its own condition, or part of the spectrum that also includes PID.
  • Normally when referring the endometritis we are referring to the pregnancy related variant. Unless otherwise specified, this is they type referred to in this article.

It is thought that infection arises from the genital tract up to the uterus, and can also progress onto the ovaries and fallopian tubes – causing sapling-oophpritis.

Endometritis can be acute or chronic.

Epidemiology

  • Occurs in 1-3% of vaginal births, but 25% of caesarian section
    • Greater risk if HIV-positive
  • Prophylactic antibiotics reduce the risk by 60-70%
    • All women undergoing caesarian section should receive prophylactic antibiotics and vaginal cleaning with a povisdone-iodine solution.
    • Neither of these things is recommended for women with vaginal delivery

Aetiology

  • Usually 2 or 3 different organisms are involved in the infection, often a mix of both aerobic  and anaerobic bacteria
  • Common organisms include:
    • Gram positive – Staph aureus, Group A and Group B streptococcus
    • Gram negative – E. Coli, Klebsiella, chalmydia, enterobacter, Neisseria
    • Anaerobic – bacteroides, Peptostreptococcus
  • Risk factors:
    • HIV
    • Prolonged rupture of membranes
    • Severe meconium staining
    • Long labour
    • Retained products of conception
    • Obesity
    • Maternal anaemia
    • Diabetes
    • History of previous pelvic infection
    • Bacterial vaginosis
    • Group B strep infection

Presentation

  • Fever
  • Pelvic pain
  • Offensive vaginal discharge
  • PV bleeding (postpartum haemorrhage)
  • Dyspareunia
  • Dysuria
  • Tachycardia

Investigations

  • FBC (raised WCC)
  • Blood culture
  • MSU
  • High vaginal swab for chlamydia / gonorrhoea
  • Endometrial biopsy is occasionally performed
  • USS is not usually useful but often performed as it may rule out other differentials

Differential Diagnosis

Management

  • Antibiotics
    • Local guidelines vary – consult yours for most accurate information
    • Typical regimen might include clindamycin and gentamicin
    • If septic, consider Tazocin + clindamicin
    • In those suitable for oral treatment, co-amoxiclav (augmentin) may be used
  • Usually hospital admission and IV antibiotics are required
    • Presence of fever, tachycardia, hypotension or other abnormal vital signs usually indicate the need for hospital admission
  • Patients usually improve rapidly – within 48-72 hours

Complications

  • Sepsis
  • Peritonitis
  • Pelvic absces
  • Haematoma

References

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