Postpartum endometritis

Background

• Any postpartum woman with fever should be assumed to have a genital tract infection

Risk Factors

1. Cesarean delivery (most important)
2. Prolonged labor
3. Prolonged ROM
4. Internal fetal or uterine monitoring
5. Large amount of meconium in amniotic fluid
6. Manual removal of placenta
7. Diabetes Mellitus
8. Preterm birth
9. Bacterial vaginosis
10. Operative vaginal delivery
11. Post-term pregnancy
12. HIV infection
13. Colonization with Group B Strep

Diagnosis

1. Fever
2. Foul-smelling lochia
3. Leukocytosis
4. Uterine tenderness
5. Only scant discharge may be present (esp w/ group B strep)

DDX

1. Respiratory tract infection
2. UTI/urosepsis
3. Pyelonephritis
4. Intra-abdominal abscess
5. Mastitis
6. Thrombophlebitis

Treatment

• Abx
  • Outpatient
    • Clindamycin 300mg PO TID
  • Inpatient
    • Clindamycin 900mg IV TID + gentamicin 1.5 mg/kg IV TID

Disposition

• Consult OB/GYN first if are considering outpt management
• Admit all pts who appear ill, have had a C-section, or underlying comorbid conditions

See Also

Post-Partum Emergencies

Source

• Tintinalli
• Rosen's