Introduction to postpartum endometritis

Postpartum endometritis is an infection of the pregnancy endometrium following delivery. The infection may extend into the myometrium and parametrium, and progress beyond the uterus, causing peritonitis and pelvic thrombophlebitis.

Postpartum endometritis is usually a polymicrobial infection, most commonly involving ascending cervicovaginal organisms. Rarely, patients who are critically ill with sepsis or septic shock may have infection caused by Clostridium species or Streptococcus pyogenes (group A streptococcus). Late-onset endometritis (occurring more than 7 days after delivery) suggests Chlamydia trachomatis infection.

Postpartum endometritis typically presents with fever (38°C or more), lower abdominal pain and uterine tenderness. Purulent vaginal discharge may be present.

The majority of endometritis cases present within the first week after delivery, but approximately 15% of cases present between 1 and 6 weeks postpartum. Late presentations are often less severe and may present as late postpartum haemorrhage. If postpartum endometritis is suspected, refer to an obstetrician for appropriate assessment and management.

For the management of endometritis unrelated to pregnancy, see Pelvic inflammatory disease and postprocedural pelvic infection.