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Introduction

Postpartum endometritis, an infection of the endometrial lining after delivery, poses a significant concern in postnatal care.  It is triggered by a polymicrobial infection from the introduction of mixed anaerobic and aerobic bacteria into the uterus during childbirth.

Pathophysiology and risk factors

Several factors contribute to the development of postpartum endometritis.  Most risk factors create opportunities for bacterial infiltration into the uterus, leading to infection and subsequent inflammation; these include:

  • Cesarean delivery (highest risk)
  • Prolonged labor
  • Prolonged, prelabor rupture of membranes
  • Multiple cervical examinations during labor
  • Operative vaginal delivery
  • Group B Streptococcus colonization

Clinical presentation

  • Fever (>38 C [100.4 F]) >24 hours postpartum (fever <24 hr postpartum is considered physiologic)
  • Uterine tenderness
  • Malodorous lochia
  • Midline lower abdominal pain
  • Soft, noncontracted uterus (leading to postpartum hemorrhage)

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