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.

Fever (often within the first few days postpartum, though onset can be delayed), lower abdominal or pelvic pain, uterine tenderness on palpation, and offensive or heavy lochia.

Tachycardia is common.

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.