Postpartum endometritis

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  • 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


  • 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

Postpartum Emergencies



<48hrs Post Partum

Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora

>48hrs Post Partum


  • 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


  • 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.