Postpartum endometritis: Difference between revisions

Revision as of 14:41, 24 August 2020

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 abscess, toxic shock syndrome, peritonitis, sepsis, septic pulmonary emboli, and myometritis

Investigations

Cervical swabs for culture
Vaginal swabs for STI NAAT
Imaging

Management

Broad-spectrum intravenous antibiotics such as clindamycin and gentamicin

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* Infection of the endometrium (uterine lining) within 10 days of delivery
+*Infection of the endometrium (uterine lining) within 10 days of delivery
-=== Microbiology ===
+===Microbiology===
-* Usually '''polymicrobial'''
+*Usually '''polymicrobial'''
-* [[Streptococcus pyogenes]]
+*[[Streptococcus pyogenes]]
-* [[Streptococcus agalactiae]]
+*[[Streptococcus agalactiae]]
-* [[Staphylococcus species]]
+*[[Staphylococcus species]]
-* [[Mycoplasma hominis]]
+*[[Mycoplasma hominis]]
-* [[Gram-negative bacilli]]
+*[[Gram-negative bacilli]]
-* [[Gardnerella vaginalis]]
+*[[Gardnerella vaginalis]]
-* [[Anaerobes]], including [[Bacteroides fragilis]], [[Clostridium sordellii]], and [[Clostridium perfringens]]
+*[[Anaerobes]], including [[Bacteroides fragilis]], [[Clostridium sordellii]], and [[Clostridium perfringens]]
-* Uncommonly associated with [[Neisseria gonorrhoeae]] or [[Chlamydia trachomatis]]
+*Uncommonly associated with [[Neisseria gonorrhoeae]] or [[Chlamydia trachomatis]]
-=== Epidemiology ===
+===Epidemiology===
-* Most common cause of postpartum fever
+*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]]
+*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 ==
+==Clinical Manifestations==
-* [[Fever]] within 10 days of delivery
+*[[Fever]] within 10 days of delivery
-** Note, however, that low-grade fever can be common within the day after delivery
+**Note, however, that low-grade fever can be common within the day after delivery
-* Malodorous or purulent vaginal discharge, or per-vaginal bleeding
+*Malodorous or purulent vaginal discharge, or per-vaginal bleeding
-* Abdominal and pelvic pain
+*Abdominal and pelvic pain
-* May become complicated by abscess, toxic shock syndrome, peritonitis, sepsis, septic pulmonary emboli, and myometritis
+*May become complicated by abscess, toxic shock syndrome, peritonitis, sepsis, septic pulmonary emboli, and myometritis
-== Investigations ==
+==Investigations==
-* Cervical swabs for culture
+*Cervical swabs for culture
-* Vaginal swabs for STI NAAT
+*Vaginal swabs for STI NAAT
-* Imaging
+*Imaging
-== Management ==
+==Management==
-* Broad-spectrum intravenous antibiotics such as [[Is treated by::clindamycin]] and [[Is treated by::gentamicin]]
+*Broad-spectrum intravenous antibiotics such as [[Is treated by::clindamycin]] and [[Is treated by::gentamicin]]
+[[Category:Obstetrical infections]]