Postpartum Endometritis

Postpartum endometritis is an infection of the uterus lining or upper genital tract that some women develop following childbirth. The term "postpartum" refers to the period of the time right after childbirth and "endometritis" is a reference to the location of the infection in the endometrium. The endometrium is the interior wall of the uterus. This inner uterine wall is where the post-delivery bacterial infection occurs with this condition.

Is postpartum endometritis life threatening? No, this infection is life-threatening in the rarest of cases. But it can cause a fever, stomach pain, vaginal bleeding… all things you do not want to be dealing with under any circumstances, much less while caring for a newborn. So you want to understand this infection and treat it as effectively as possible.

What Causes Postpartum Endometritis?

Postpartum endometritis is a bacterial infection, so it is caused by the infiltration of bacteria into the inner lining of the womb.

The bacteria typically migrates into the endometrium during the labor and delivery process and grows into a full-blown infection in the following days or weeks.

Postpartum endometritis infections usually develop fairly soon after delivery. Most cases are diagnosed within the first 10 days after childbirth. However, postpartum endometritis can sometimes take longer to develop and the condition can occur anytime within the first 6 weeks after delivery.

Postpartum endometritis can be caused by any type of bacterial, but the most common pathogens involved in this infection are group B streptococci and staphylococcus (staph).

Risk Factors for Postpartum Endometritis

Chart for Incidence rate for Postpartum EndometritisPostpartum endometritis is much more common after a C-section delivery compared to a normal vaginal delivery. After a regular, vaginal delivery, the reported incidence rate of postpartum endometritis is about 1-3%. The incidence rate for postpartum endometritis is 5-10 times higher after a C-section delivery. This makes a C-section delivery the primary risk factor for this condition.

Aside from C-section delivery, other known risk factors that make postpartum endometritis more likely to develop include:

  • Prolonged labor: in prolonged labor where a long period of time passes between the rupture of the fetal membranes and delivery, internal infections are more likely to occur.
  • Maternal Infection: if the mother develops an infection during pregnancy (or has an active infection when she goes into labor) she is more likely to develop postpartum endometritis.
  • Internal Examinations: if doctors or nurses perform a lot of internal examinations during labor and delivery it will increase the risk of bacteria getting into the womb and developing into postpartum endometritis.
What Are the Symptoms of Postpartum Endometritis?

The primary symptom associated with postpartum endometritis is fever. An elevated temperature is almost always one of the first symptoms of this condition and it occurs in just about every case. Other common symptoms include:

  • Pain or mild swelling in the abdomen
  • Abnormal smelling vaginal discharge
  • Pain during sex or urination

The problem with identifying the symptoms of postpartum endometritis is that it can be difficult to tell what is normal in the weeks after giving birth.

How Does Placental Removal Tie into Endometritis?

Doctors remove the placenta one of two ways. The first is to wait for the placenta to separate from the uterus. The second is the doctor can take her hand and form a cleavage plane between the placenta and the wall of the uterus. The latter is called manual removal of the placenta. This increases the likelihood of postpartum endometritis. Why? Because you are breaking up blood vessels. This causes more raw surfaces to emerge which are breeding grounds for preexisting bacteria in the endometrial cavity.

Diagnosis and Treatment of Postpartum Endometritis

Postpartum endometritis is initially diagnosed through physical examination and observation of symptoms. This may include a vaginal examination or swab. The diagnosis can be confirmed through blood and urine testing.

Most cases of postpartum endometritis can be effectively treated with basic antibiotics that you take at home. The 2nd generation antibiotic clindamycin is usually prescribed in combination with another type of antibiotic (usually gentamicin). These are often given by injection in an outpatient setting. In some cases, women with postpartum endometritis may be treated in a hospital setting and given antibiotics intravenously.

What Are the Risks and Complication of Postpartum Endometritis?

As long as postpartum endometritis is diagnosed quickly, it can usually be effectively treated without any long-term health implications. When the condition is not immediately diagnosed, however, it can spread very quickly inside the women's body. If postpartum endometritis goes undiagnosed and untreated, the worst-case scenario is that it could progress into sepsis. Sepsis is an infection in the bloodstream that can often be fatal.

Is Prophylactic Antibiotics Wise to Prevent Postpartum Endometritis and Other Infections?

Prophylactic antibiotics is an option to prevent postpartum endometritis, especially for women who have a C-section. Vaginal cleaning before delivery has also been shown to reduce the risk of postpartum endometritis?

Medical Literature on Postpartum Endometritis

We link to good bit of medical literature on postpartum endometritis above. Here are some more articles in you are looking to take a deeper dive into the topic.

  • Puente E, et. al: Chronic endometritis: old problem, novel insights and future challenges. Int J Fertil Steril. 2020; 13: 250-256
  • Knight M, et al: Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Lancet 2020; 393:2395.
  • Baksu A, et. al: The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss. Acta Obstet Gynecol Scand 2005; 84:266.
  • Chaim W, et al: Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000; 8:77.
  • Atkinson MW, et. al: The effect of manual removal of the placenta on post-cesarean endometritis. Obstet Gynecol 1996; 87:99.