Postpartum endometritis

Question 1

What is the definition of endometritis?

Answer 1

inflammation of the endometrial, usually caused by infection

Question 2

Why can endometritis occur postpartum?

Answer 2

infection is introduced during or after labor and delivery; process of delivery opens the uterus to allow bacteria from the vagina to travel upwards and infect the endometrium

Question 3

What is the single biggest risk facto for postpartum endometritis?

Answer 3

caesarean section rather than vaginal delivery

Question 4

What is done during a caesarean section to reduce the risk of endometritis?

Answer 4

prophylactic antibiotics are given during caesarean

Question 5

What are 4 examples of organisms which can cause endometritis?

Answer 5

1. Gram-positive cocci - Staphylococcus spp, Group A and B streptococcus
2. Gra negative - E. coli, Klebsiella, Proteus, Enterobcter, Gardnerella vaginalis, Neisseria
3. Anaerobes - Bacteroides, Peptostreptococcus
4. Sexually transmitted - chlamydia and gonorrhoea

Question 6

What are 5 possible features of the presentation of endometritis?

Answer 6

1. Foul-smelling discharge or lochia
   
   • lochia = normal discharge from woman after birth
2. Bleeding that gets heavier or does not improve with time
   
   • postpartum haemorrhage
3. Lower abdominal or pelvic pain
4. Fever
5. Sepsis

Question 7

Within what time frame can postpartum endometritis present?

Answer 7

from shortly after birth to several weeks postpartum

Question 8

What are 4 types of investigations for suspected postpartum endometritis?

Answer 8

1. Vaginal swabs - including chlamydia and gonorrhoea if RFs
2. Urine cultures and sensitivities
3. Ultrasound - to rule out retinaed products of conception
4. Sepsis 6 if sepsis: blood culture, urine output monitoring, lactate

Question 9

How are patients presenting in the community with endometritis treated, if milder symptoms and no signs of sepsis?

Answer 9

broad spectrum oral antibiotic e.g. co-amoxiclav

Question 10

What is the management of a woman with more severe postpartum endometritis in hospital?

Answer 10

if septic: blood cultures, broad-spectrum IV antibiotics (according to local guidelines)

combination of clindamycin PLUS tazocin or a carbapenem

Question 11

In what setting can endometritis occur not related to pregnancy?

Answer 11

pelvic inflammatory disease