Postpartum Endometritis

Infection of the endometrium (and often the myometrium and parametrial tissue) following delivery, more common after cesarean section (roughly 5 to 10 times the risk compared with vaginal delivery) than vaginal birth, and further increased by prolonged labor, prolonged rupture of membranes, multiple vaginal examinations, and retained products of conception.

Typically polymicrobial, reflecting ascending genital tract flora.

Primarily clinical, based on the combination of fever, uterine tenderness, and abnormal lochia in the appropriate postpartum timeframe. FBC (leukocytosis), CRP, blood cultures, and high vaginal/endocervical swabs support diagnosis and guide any subsequent antibiotic adjustment, though empirical treatment should not be delayed pending results. Pelvic ultrasound if retained products of conception is suspected as a contributing or complicating factor.

IV antibiotics: a commonly used regimen is IV clindamycin 900 mg tds plus gentamicin (dosed by weight, typically 5 to 7 mg/kg once daily with renal function monitoring), reflecting good coverage of the typical polymicrobial, including anaerobic, flora; alternatives include IV co-amoxiclav 1.2 g tds, per local protocol and severity
Continue IV antibiotics until the woman is afebrile and clinically improving for at least 24 to 48 hours, then no routine need for a further oral course in most straightforward cases, per current evidence, though practice varies by local protocol
Evaluate for and manage retained products of conception if identified (see that entry) as a contributing factor requiring specific evacuation
Analgesia and supportive care
Escalate per the Puerperal Sepsis entry if features of systemic sepsis or failure to respond to initial antibiotics develop

Referral: obstetric-led inpatient management; gynecology input if surgical evacuation of retained products is needed.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Puerperal Sepsis

Sepsis arising in the postpartum period, most commonly originating from the genital tract (endometritis, see that entry, being the most common specific source), though also from the urinary tract, surgical wounds (cesarean section, episiotomy or perineal repair), breast (mastitis, see that entry, though this rarely progresses to systemic sepsis unless complicated by abscess), or, more rarely, from an unrelated source. Remains a leading cause of maternal mortality globally, and the general principles of sepsis recognition and management (see that entry) apply, with physiological changes of pregnancy and the puerperium (relative tachycardia, physiological leukocytosis) sometimes masking or delaying recognition.

Sepsis Six bundle principles apply immediately: oxygen, blood cultures before antibiotics where feasible, IV fluids, lactate measurement, urine output monitoring, and broad-spectrum IV antibiotics within the hour, with empirical coverage broad enough for polymicrobial genital tract infection (commonly a combination such as IV co-amoxiclav 1.2 g tds plus metronidazole, or IV piperacillin-tazobactam 4.5 g tds, or, where group A streptococcus is a specific concern given its rapid, severe course, adding clindamycin for its additional toxin-suppressing effect) per local sepsis protocol and severity
Source control is essential and should not be delayed: evacuation of retained products (see that entry), wound debridement or drainage if a surgical site collection is present, catheter removal or urinary source management as relevant
Escalation to ICU/HDU for evolving septic shock, following the principles detailed in that entry
Group A streptococcal sepsis carries a particularly rapid and severe course in the puerperium and should be treated with a high index of suspicion and aggressive early management given its capacity for rapid deterioration

Referral: obstetric and, where relevant, gynecology/surgical input for source control; ICU for severe sepsis or septic shock.

Postpartum Endometritis

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management