Puerperal endometritis

Puerperal endometritis is the infection of the endometrium, the tissue that lines the inside of the uterus, that occurs within the first two weeks postpartum.

It is often caused by bacteria ascending from the lower genital tract or urogenital tract into the uterus. Premature rupture of the uterus, prolonged labor, a history of group B streptococcus infection during pregnancy, cesarean or instrumental delivery, are risk factors that predispose to the development of endometritis.

The most common presentation is fever, which may also be associated with abdominal pain, constant genital bleeding and foul-smelling vaginal discharge. Without treatment, the clinical picture can become potentially serious, evolving to diffuse pelviperitonitis or even to a generalized infection such as sepsis.

For diagnosis, the clinical history is relevant, taking into account risk factors, and the gynecological examination to assess the presence of vaginal bleeding and the characteristics of the discharge. Cultures should be taken from samples collected from the cervix and vagina. To assess whether there is a serious infection, a blood test should be requested, which is accompanied by a blood culture if fever is present. Finally, a gynecological ultrasound should be performed to rule out the presence of placental debris inside the uterus. 

Treatment is with antipyretics and antibiotics. Hospitalization may be required until symptoms and infection parameters improve. In cases where placental debris is evident, surgical evacuation by hysteroscopy or curettage may be necessary.