Postpartum endometritis: Difference between revisions
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*Usually '''polymicrobial''' |
*Usually '''polymicrobial''' |
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+ | *Gram-positives: |
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− | *[[Streptococcus |
+ | **[[Streptococcus pyogenes]] |
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− | *[[Staphylococcus]] |
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+ | **[[Staphylococcus aureus]] and [[Staphylococcus epidermidis]] |
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− | *[[Mycoplasma hominis]] |
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+ | **[[Viridans group streptococci]] |
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− | *[[Gram-negative bacilli]] |
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+ | **Other [[streptococci]] |
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+ | *Gram-negatives: |
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+ | **[[Escherichia coli]] |
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+ | **[[Klebsiella pneumoniae]] |
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+ | **[[Proteus mirabilis]] |
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+ | **[[Klebsiella aerogenes]] |
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+ | **[[Morganella morganii]] |
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+ | *Anaerobes: |
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+ | **[[Bacteroides fragilis]] and other [[Bacteroides]] species |
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+ | **[[Peptococcus]], [[Peptostreptococcus]] |
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+ | **[[Fusobacterium]] |
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+ | *Others: |
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===Epidemiology=== |
===Epidemiology=== |
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*Abdominal and pelvic pain |
*Abdominal and pelvic pain |
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*May become complicated by [[bacteremia]], abscess, [[toxic shock syndrome]], [[peritonitis]], [[sepsis]], [[myometritis]], and [[septic pulmonary emboli]] or [[septic pelvic thrombophlebitis]] |
*May become complicated by [[bacteremia]], abscess, [[toxic shock syndrome]], [[peritonitis]], [[sepsis]], [[myometritis]], and [[septic pulmonary emboli]] or [[septic pelvic thrombophlebitis]] |
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+ | == Diagnosis == |
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+ | * At least two or more of: |
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+ | ** Fever >= 38 Celsius |
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+ | ** Pain or tenderness (uterine or abdominal) without other cause |
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+ | ** Purulent drainage from the uterus (some degree of malodorous yellow-red lochia is normal after delivery, however) |
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==Investigations== |
==Investigations== |
Revision as of 11:10, 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