Postpartum Endometritis

Endometritis refers to inflammation of the endometrium, usually caused by infection. It can occur in the postpartum period, as infection is introduced during or after labour and delivery. The process of delivery opens the uterus to allow bacteria from the vagina to travel upwards and infect the endometrium.

Endometritis occurs more commonly after caesarean section compared with vaginal delivery. Prophylactic antibiotics are given during a caesarean to reduce the risk of infection.

Endometritis can be caused by a large variety of gram-negativegram-positive and anaerobic bacteria. It can also be caused by sexually transmitted infections such as chlamydia and gonorrhoea.

When endometritis occurs unrelated to pregnancy and delivery, it is usually part of pelvic inflammatory disease, which is covered elsewhere.

 

Presentation

Postpartum endometritis can present from shortly after birth to several weeks postpartum. It can present with:

  • Foul-smelling discharge or lochia
  • Bleeding that gets heavier or does not improve with time
  • Lower abdominal or pelvic pain
  • Fever
  • Sepsis

 

Diagnosis and Management

Investigations to help establish the diagnosis include:

  • Vaginal swabs (including chlamydia and gonorrhoea if there are risk factors)
  • Urine culture and sensitivities

 

Ultrasound may be considered to rule out retained products of conception (although it is not used to diagnose endometritis).

Septic patients will require hospital admission and the septic six, including blood cultures and broad-spectrum IV antibiotics (according to local guidelines). A combination of clindamycin and gentamicin is often recommended. Blood tests will show signs of infection (e.g. raised WBC and CRP).

Patients presenting with milder symptoms and no signs of sepsis may be treated in the community with oral antibiotics. A typical choice of broad-spectrum oral antibiotic might be co-amoxiclav, depending on the risk of chlamydia and gonorrhoea.

 

Last updated September 2020
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