Postpartum endometritis

Background

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

Risk Factors

Cesarean delivery (most important)***
Prolonged labor
Prolonged rupture of membranes
Multiple cervical examinations
Internal fetal or uterine monitoring
Large amount of meconium in amniotic fluid
Manual removal of the placenta
Low socioeconomic status
Maternal diabetes mellitus or severe anemia
Preterm birth
Bacterial vaginosis
Operative vaginal delivery
Postterm pregnancy
HIV infection
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

Nearly all warrant admission to OB-Gyn service

Rarely mild late postpartum endometritis can take PO antibiotics, but this is very rare

Evidence Based Questions

Insert

Source

Adapted from Rosen's, Tintinalli's

Authors: