Postpartum endometritis

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For endometritis unrelated to pregnancy, see Pelvic inflammatory disease (PID).


  • Any postpartum woman with fever should be assumed to have a genital tract infection
  • Postpartum women have a 20-fold increase in invasive group A streptococcal infection compared with nonpregnant women.
  • Most often polymicrobial, requiring broad spectrum antibiotics
  • Maternal mortality is highest if infection develops within 4 days of delivery

Risk Factors

  • Cesarean delivery (most important)
  • Prolonged labor
  • Prolonged or premature 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

Clinical Features

Differential Diagnosis

3rd Trimester/Postpartum Emergencies




<48hrs Post Partum

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

>48hrs Post Partum

  • Doxycycline 100mg IV or PO q12hrs + Metronidazole 500mg IV or PO q8hrs daily
    • Use Metronidazole with caution in breastfeeding mothers its active is present in breast milk at concentrations similar to maternal plasma concentrations


  • 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


  1. Stevens DL and Bryant A. Pregnancy-related group A streptococcal infection.
  2. Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015 Feb 2;2015(2):CD001067. doi: 10.1002/14651858.CD001067.pub3. PMID: 25922861; PMCID: PMC7050613