Postpartum endometritis

Background

RF (+no abx prophy)	Rate
Nonelective cesarean	30%
Elective cesarean	7%
Vaginal delivery	3%

Risk Factors

1. Cesarean delivery (most important)***
2. Prolonged labor
3. Prolonged rupture of membranes
4. Multiple cervical examinations
5. Internal fetal or uterine monitoring
6. Large amount of meconium in amniotic fluid
7. Manual removal of the placenta
8. Low socioeconomic status
9. Maternal diabetes mellitus or severe anemia
10. Preterm birth
11. Bacterial vaginosis
12. Operative vaginal delivery
13. Postterm pregnancy
14. HIV infection
15. Colonization with group B streptococcus

Diagnosis

• fever
• uterine tenderness
• foul lochia
• mild vaginal bleeding
• NSVD --> late endometritis & polymicrobial
• Csection --> earlier endometrtitis

Work-Up

Fever or sepsis lab workup and cultures

Pelvic Ultrasound

- pelvic fluid collection

- adnexal collection/hematoma

CT AP if neg US and high suspicion

- uterine fluid, debris and gas

DDx

UTI/urosepsis

Intra-abdominal abscess

Septic pelvic vein thrombophlebitis

Pelvic DVT

Treatment

Harbor

- Clinda and Gent

OR

- Ceftriaxona and Gent

Elsewhere

- Zosyn, Unasyn, Ticarcillin/Clavulanate

PCN Allergy

- Ertapenem (preferred), Imipenem

- Clindamycin & Gentamicin

OB consultation for invasive management

Disposition

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Evidence Based Questions

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See Also

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Source

Adapted from ....(insert)