Postpartum Endometritis

Any postpartum women presenting with persistent fever of >38.0C should be assumed to have a genital tract infection until proven otherwise. Other common sources of fever include respiratory tract infection, UTIs, mastitis, and thrombophlebitis. However, Pelvic infection is the most common serious complication of the puerperium.

Risk factors of Postpartum Endometritis

• Cesarean Section
• Multiple Gestation
• Younger maternal age
• Prolonged labour and PROM
• Internal fetal monitoring
• Digital examination 
• Immunocompromised state

Common Bugs (reside in the bowel and colonize the perineum, vagina, and cervix) 

• Gram-positive and gram-negative aerobes, anaerobes
• Chlamydia trachomatis, and Neisseria gonorrhoea
• Gardnerella vaginalis is isolated more often in younger women. 
• MRSA

Many infections are polymicrobial

Clinical Presentation

• Fever 38.0C 
• Foul-smelling loch
• Leukocytosis
• Tachycardia
• Uterine tenderness

ED Management

• ABC
• General Sepsis Care (Fluids, Antibiotics, Cultures, Septic Screen). Combination of Ampicillin or Clindamycin plus gentamicin is sufficient for 90% of patients
• Drainage of abscesses and purulent material or debridement of necrotic tissue 
• OBGYN Consultation 

Complications of endometritis include parametrical spread of infection, pelvic abscesses; infected hematomas; septic pelvic thrombophlebitis; necrotizing fasciitis; and peritonitis. 

Posted by:

              

     Lakshay Chanana

     

     Speciality Doctor

     Northwick Park Hospital

     Department of Emergency Medicine

     England

     @EMDidactic