Puerperal endometritis

Postpartum endometritis is the infection of the endometrium, the tissue that lines the interior of the uterus, and can manifest in between the first 2 weeks of postpartum.

It is frequently caused by bacteria that move from the inferior genital aparatus up to the urogenital uterus tract. The premature sac rupture, a prolonged labour, group B streptococcus infection history during pregnancy and caesarean or instrumented labour are risk factors that have an impact on endometritis development.

Its most habitual manifestations are fever with associated abdominal pain, constant genital bleeding and foul-smelling vaginal discharge. Without any treatment, it can develop into a potentially severe pelvic peritonitis or even a generalised infection.

For its diagnosis it is relevant the patient’s clinical history taking into consideration the risk factors and the gynaecological exploration to assess the presence of vaginal bleeding and its discharge characteristics. Uterine neck and vaginal samples must be collected. To assess if there can be an acute infection, a blood analysis must be done followed by a blood culture if there is fever. Lastly, a gynaecological ultrasound must be performed to rule out the presence of placentary remains inside the uterus.

Treatment is based on antipyretics and antibiotics. It can require inpatient treatment until further improvement and infection parameters are controlled. In cases where placentary remains are evident, it can be necessary surgical evacuation through a hysteroscopy or curettage.