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Endometritis and Other Postpartum Infections

Justin P. Lavin, Jr., MD, FACOG, Cassandra Heiselman, DO, MPH and Michelle N. Lende, DO Reviewed 06/2020
 


BASICS

DESCRIPTION

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

  • Bacterial infection of genital tract, usually within the 1st week after delivery, can occur as lat...

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
Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Sys Rev.  2014;(10):CD007482. [View Abstract on ...

ADDITIONAL READING

  • Baaqeel H, Baaqeel R. Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis. BJOG.  2013;120(6):661–669. [View Abstr...

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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