Postpartum endometritis
INTRODUCTION
Postpartum (puerperal) endometritis refers to a postpartum infection of the decidua (ie, pregnancy endometrium) that can affect all layers of the uterus. It is a common cause of postpartum fever and uterine tenderness and 10- to 30-fold more common after cesarean than vaginal birth. Most infections are mild and resolve with antibiotic therapy; however, in a minority of patients, the infection extends into the peritoneal cavity potentially resulting in peritonitis, intraabdominal abscess, or sepsis. Rare patients develop necrotizing myometritis, necrotizing fasciitis of the abdominal wall, septic pelvic thrombophlebitis, or toxic shock syndrome.Endometritis after a vaginal or cesarean birth will be discussed here. Endometritis in patients who have had a pregnancy termination or spontaneous pregnancy loss and those who have not been recently pregnant is reviewed separately. (See "Overview of pregnancy termination", section on 'Infection/retained products of conception' and "Retained products of conception in the first half of pregnancy", section on 'Medically stable patients with endometritis' 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 lower genital tract. Microbiology is similar to that of chorioamnionitis [1]. In a study of 55 antibiotic-naive patients with well-defined postpartum endometritis who had endometrial cultures obtained with a triple-lumen catheter (to reduce the risk of contamination from organisms on the cervix), 51 (93 percent) had an endometrial isolate and seven (13 percent) had a blood isolate [2]. Bacterial findings included:●At least one facultative or one anaerobic bacterial species – 42 of 51 (82 percent).
●Genital mycoplasmas – 39 of 51 (76 percent).
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