Postpartum endometritis

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