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Postpartum endometritis

Author
Katherine T Chen, MD, MPH
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Postpartum endometritis refers to infection of the decidua (ie, pregnancy endometrium). The infection may also extend into the myometrium (called endomyometritis) or involve the parametrium (called parametritis).

Postpartum endometritis is a common cause of postpartum febrile morbidity. The United States Joint Commission on Maternal Welfare defines postpartum febrile morbidity as an oral temperature of ≥38.0 degrees Celsius (≥100.4 degrees Fahrenheit) on any 2 of the first 10 days postpartum, exclusive of the first 24 hours [1]. The first 24 hours are excluded because low grade fever during this period is common and often resolves spontaneously, especially after vaginal birth [2].

Endometritis after a vaginal or cesarean delivery will be discussed here. Endometritis after a miscarriage or abortion, or in women who have not been recently pregnant, is reviewed separately. (See "Overview of pregnancy termination", section on 'Infection/retained products of conception' and "Endometritis unrelated to pregnancy".)

MICROBIOLOGY

Postpartum endometritis is typically a polymicrobial infection involving a mixture of two to three aerobes and anaerobes from the genital tract. This was illustrated in a study of 55 women with well-defined puerperal endometritis who had endometrial cultures obtained with a triple-lumen catheter to reduce the risk of contamination from organisms on the cervix [3]. None of the women had received prophylactic antibiotics. More than one organism was recovered from 70 percent of these women; approximately 60 percent of the isolates were facultative gram positive and gram negative bacteria, approximately 40 percent were anaerobes, and 30 percent were mycoplasmas.

Although mycoplasmas are often isolated from the endometrial cavity, antibiotic therapy is not usually required for clinical cure in women who have Ureaplasma urealyticum only, without additional organisms [4-6]. Thus, the role of mycoplasmas in the pathogenesis of endometritis is unclear.

                            

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Literature review current through: Nov 2016. | This topic last updated: Fri Sep 09 00:00:00 GMT+00:00 2016.
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