Postpartum endometritis: Difference between revisions

Revision as of 15:10, 3 March 2023

Background

Infection of the endometrium (uterine lining) within 10 days of delivery

Microbiology

Usually polymicrobial
Gram-positives:
Gram-negatives:
Anaerobes:
- Bacteroides fragilis and other Bacteroides species
- Clostridium sordellii, and Clostridium perfringens
- Peptococcus, Peptostreptococcus
- Fusobacterium
Others:
- Gardnerella vaginalis
- Uncommonly associated with Neisseria gonorrhoeae or Chlamydia trachomatis

Epidemiology

Most common cause of postpartum fever
More common after Cesarean section, PROM, preterm or postterm delivery, chorioamnionitis, prolonged labor, maternal anemia, maternal diabetes, multiple vaginal examinations, and bacterial vaginosis

Clinical Manifestations

Fever within 10 days of delivery
- Note, however, that low-grade fever can be common within the day after delivery
Malodorous or purulent vaginal discharge, or per-vaginal bleeding
Abdominal and pelvic pain
May become complicated by bacteremia, abscess, toxic shock syndrome, peritonitis, sepsis, myometritis, and septic pulmonary emboli or septic pelvic thrombophlebitis

Diagnosis

At least two or more of:
- Fever >= 38 Celsius
- Pain or tenderness (uterine or abdominal) without other cause
- Purulent drainage from the uterus (some degree of malodorous yellow-red lochia is normal after delivery, however)

Investigations

Cervical swabs for culture
Vaginal swabs for STI NAAT
Imaging

Management

Broad-spectrum intravenous antibiotics such as clindamycin and gentamicin

@@ Line 6: / Line 6: @@
 *Usually '''polymicrobial'''
+*Gram-positives:
-*[[Streptococcus pyogenes]]
-*[[Streptococcus agalactiae]]
+**[[Streptococcus pyogenes]]
+**[[Streptococcus agalactiae]]
-*[[Staphylococcus]]
+**[[Staphylococcus aureus]] and [[Staphylococcus epidermidis]]
-*[[Mycoplasma hominis]]
+**[[Viridans group streptococci]]
-*[[Gram-negative bacilli]]
+**Other [[streptococci]]
-*[[Gardnerella vaginalis]]
+*Gram-negatives:
-*[[Anaerobes]], including [[Bacteroides fragilis]], [[Clostridium sordellii]], and [[Clostridium perfringens]]
+**[[Escherichia coli]]
-*Uncommonly associated with [[Neisseria gonorrhoeae]] or [[Chlamydia trachomatis]]
+**[[Klebsiella pneumoniae]]
+**[[Proteus mirabilis]]
+**[[Klebsiella aerogenes]]
+**[[Morganella morganii]]
+*Anaerobes:
+**[[Bacteroides fragilis]] and other [[Bacteroides]] species
+**[[Clostridium sordellii]], and [[Clostridium perfringens]]
+**[[Peptococcus]], [[Peptostreptococcus]]
+**[[Fusobacterium]]
+*Others:
+**[[Gardnerella vaginalis]]
+**Uncommonly associated with [[Neisseria gonorrhoeae]] or [[Chlamydia trachomatis]]
 ===Epidemiology===
@@ Line 27: / Line 39: @@
 *Abdominal and pelvic pain
 *May become complicated by [[bacteremia]], abscess, [[toxic shock syndrome]], [[peritonitis]], [[sepsis]], [[myometritis]], and [[septic pulmonary emboli]] or [[septic pelvic thrombophlebitis]]
+== Diagnosis ==
+* At least two or more of:
+** Fever >= 38 Celsius
+** Pain or tenderness (uterine or abdominal) without other cause
+** Purulent drainage from the uterus (some degree of malodorous yellow-red lochia is normal after delivery, however)
 ==Investigations==