Postpartum endometritis: Difference between revisions
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*Malodorous or purulent vaginal discharge, or per-vaginal bleeding |
*Malodorous or purulent vaginal discharge, or per-vaginal bleeding |
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*Abdominal and pelvic pain |
*Abdominal and pelvic pain |
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*May become complicated by abscess, toxic shock syndrome, peritonitis, sepsis, septic pulmonary emboli |
*May become complicated by [[bacteremia]], abscess, [[toxic shock syndrome]], [[peritonitis]], [[sepsis]], [[myometritis]], and [[septic pulmonary emboli]] or [[septic pelvic thrombophlebitis]] |
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==Investigations== |
==Investigations== |
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Revision as of 13:32, 10 December 2021
Background
- Infection of the endometrium (uterine lining) within 10 days of delivery
Microbiology
- Usually polymicrobial
- Streptococcus pyogenes
- Streptococcus agalactiae
- Staphylococcus species
- Mycoplasma hominis
- Gram-negative bacilli
- Gardnerella vaginalis
- Anaerobes, including Bacteroides fragilis, Clostridium sordellii, and Clostridium perfringens
- 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
Investigations
- Cervical swabs for culture
- Vaginal swabs for STI NAAT
- Imaging
Management
- Broad-spectrum intravenous antibiotics such as clindamycin and gentamicin
