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Endometritis and Other Postpartum Infections

Justin P. Lavin, Jr., FACOG, MD and Sarah E Davis, DO Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Endometritis (infection of the endometrium) is the most common postpartum infection.

  • Bacterial infection of genital tract, manifesting after delivery with a peak incidence at postpart...

DIAGNOSIS

HISTORY

  • History of cesarean delivery or chorioamnionitis

  • Fever and chills

  • Malaise

  • Headache

  • Anorexia

  • Abdominal pain

  • Heavy vaginal bleeding or foul smelling lochia

PHYSICAL EXAM

  • Oral temperature >38...

TREATMENT

MEDICATION

First Line

Clindamycin 900 mg IV q8h + gentamicin 5 mg/kg IV q24h (6)[A
  • Potential side effects include nephrotoxicity, ototoxicity, pseudomembranous colitis, or diarrhea (in up to...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Individualize according to severity.

  • IV antibiotics can be stopped when the patient is afebrile for 24 to 48 hours.

  • Oral antibiotics on discharge ...

REFERENCES

1
Knight M, Chiocchia V, Partlett C, Oliver Rivero-Arias O, et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised ...

ADDITIONAL READING

  • Carter EB, Temming LA, Fowler S, et al. Evidence-Based Bundles and Cesarean Delivery Surgical Site Infections: A Systematic Review and Meta-analysis. Obstet Gyn...

SEE ALSO

Algorithm: Pelvic Pain 

CODES

ICD10

  • O86.12 Endometritis following delivery

  • O86.4 Pyrexia of unknown origin following delivery

  • O86.13 Vaginitis following delivery

  • O85 Puerperal sepsis

  • O86.19 Other infection of genital tract follow...

CLINICAL PEARLS

  • Postpartum endometritis follows 1–3% of all births.

  • Infections are typically polymicrobial and involve organisms ascending from the lower genital tract.

  • Evidence supports antibiotic prop...

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