Postpartum endometritis
- Definition & Etiology:
- Most common cause of postpartum fever (day 2–3).
- Polymicrobial: Vaginal flora (anaerobes: Bacteroides, Peptostreptococcus; aerobes: E. coli, GBS).
- Risk Factors:
- Cesarean delivery (single most important risk factor).
- PROM (>18 hrs), prolonged labor, operative vaginal delivery, chorioamnionitis.
- Clinical Features:
- Postpartum fever (≥38.0°C / 100.4°F) on day 2–3.
- Foul-smelling / purulent lochia.
- Uterine / fundal tenderness, lower abdominal pain, leukocytosis.
- Diagnosis:
- Clinical: Fever + uterine tenderness + foul lochia post-delivery.
- Pelvic US: Indicated only if refractory to Abx to rule out RPOC or pelvic abscess.
- Endometrial cultures not routinely recommended (contamination risk).
- Management:
- 1st-line: IV Clindamycin + IV Gentamicin until afebrile x 24–48 hrs (add Ampicillin if non-responsive or Enterococcus suspected). c
- Refractory (>48–72 hrs Abx):
- Pelvic US: Check for RPOC (treat w/ D&C) or Abscess (treat w/ drainage).
- Septic Pelvic Thrombophlebitis (SPT): Suspect if US (-) and fever persists -> add therapeutic heparin.
- Key Differentials:
- Chorioamnionitis: Intrapartum presentation (fetal tachycardia, fever before delivery).
- Wound Infection: Incisional erythema/drainage without fundal tenderness.
- SPT: Persistent fever despite 48–72 hrs of broad-spectrum IV Abx + negative imaging.
- Complications: Sepsis, pelvic abscess, SPT, Asherman syndrome.