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Postpartum endometritis
From WikEM
Contents
Background
- Any postpartum woman with fever should be assumed to have a genital tract infection
- Most often polymicrobial, requiring broad spectrum antibiotics
Risk Factors
- Cesarean delivery (most important)
- Prolonged labor
- Prolonged rupture of membranes
- Internal fetal or uterine monitoring
- Large amount of meconium in amniotic fluid
- Manual removal of placenta
- Diabetes Mellitus
- Preterm birth
- Bacterial vaginosis
- Operative vaginal delivery
- Post-term pregnancy
- HIV infection
- Colonization with Group B Strep
Evaluation
- Fever
- Foul-smelling lochia
- Leukocytosis
- Uterine tenderness
- Only scant discharge may be present (esp with group B strep)
- Evaluate for retained products of conception
Differential Diagnosis
- Respiratory tract infection
- UTI/urosepsis
- Pyelonephritis
- Intra-abdominal abscess
- Thrombophlebitis
Postpartum Emergencies
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- Postpartum endometritis
- Postpartum headache
- HELLP syndrome
- Postpartum hemorrhage
- Mastitis
- Peripartum cardiomyopathy
- Preeclampsia
- Retained products of conception
- Uterine rupture
Management
Antibiotics
<48hrs Post Partum
Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora
- Clindamycin 900mg q8hrs PLUS Gentamicin 1.5mg/kg IV q8hrs OR
- Doxycycline 100mg IV PO q12hrs daily PLUS
- Ampicillin/Sulbactam 3g IV q6hrs
- Cefoxitin 2g IV q6hrs daily
>48hrs Post Partum
- Doxycycline 100mg IV or PO q12hrs + Metronidazole 500mg IV or PO q8hrs daily
Disposition
- Consult OB/GYN first if are considering outpatient management
- Admit all patients who appear ill, have had a C-section, or underlying comorbid conditions
See Also
References
- Watts D et al. Bacterial vaginosis as a risk factor for post-cesarean endometritis. Obstet Gynecol. 1990 Jan; 75(1): 52-8.
- Smaill F et al. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002;(3):CD000933.
