Postpartum Endometritis

    Postpartum endometritis is a common cause of fever after childbirth. It is initially diagnosed when there is a fever (>=38.0 Celsius or 100.4 Fahrenheit) after delivery on two separate occasions and there are usually other signs of uterine infections such as uterine pain or tenderness and/or abnormal uterine lochia. Postpartum endometritis is more common after cesarean delivery than after vaginal delivery.

    Major predisposing factors for postpartum endometritis include prior infections, prolonged labor, prolonged rupture of membranes, and cesarean section. 

    There are several potential complications that may develop as a result of postpartum endometritis, including:

    • infections of the bloodstream (bacteremia)
    • infection and thrombosis of the pelvic blood vessels (septic pelvic vein thrombophlebitis)
    • pelvic abscess
    • septic shock.

    Prompt diagnosis and aggressive treatment of endometritis is essential to prevent these complications.

    Septic pelvic vein thrombophlebitis, a condition in which blood clots in one or more of the pelvic vessels become infected, is a rare infection that can follow postpartum endometritis. Uterine infections allow bacteria to get into the venous circulation. Once in the bloodstream, bacteria can damage the lining of the blood vessels and initiate clot formation. Septic pelvic vein thrombophlebitis can lead to an abscess in the pelvis, as well as septic pulmonary embolization, in which infected blood clots travel from the pelvic vessels to the vessels in the lung and can lead to death.

    Septic shock is a severe systemic infection usually caused by bacteria and sometimes follows postpartum endometritis. Bacteria invade the bloodstream and release a substance known as endotoxin, which causes decreased blood pressure, clot formation, major tissue injury, and leakage of fluids. As a result, many organs fail because they are not receiving enough blood and nutrients. This is a serious complication but, fortunately, it is not common.

    The most common organisms found in postpartum endometritis include:

    • Group B Streptococcus
    • Mixed anaerobic and aerobic bacteria
    • Staphylococcus
    • Enterococcus
    • Klebsiella
    • Proteus
    • Bacteroides
    • Peptococcus
    • Gardnerella vaginalis
    • Ureaplasma

    Postpartum endometritis is usually treated with broad-spectrum antibiotics.