Related to this topic: Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Endometritis
| This is infection of the endometrium. It can be divided into pregnancy related (obstetric) and non-obstetric, acute and chronic. |
The accepted wisdom is that infection, usually having travelled from the lower genital tract, attacks the endometrium. Spread occurs from there to the tubes and ovaries, causing salpingoopheritis. More recent work has questioned whether endometritis is a discreet condition or part of a continuum.1
Incidence
- 1-3% after spontaneous (uncomplicated) vaginal delivery.
- May rise as high as 19-40% after caesarean section, depending on risk factors surrounding the decision to operate, and protocol on prophylactic antibiotics. Prophylaxis with cephalosporin has not been shown to reduce risk of endometritis2, but extending coverage, (with doxycycline and azithromycin) has.3
It is the most common cause of postnatal morbidity between day 2 and day 10. Due to the nature of the complaint it is most common in females of reproductive age.
- Acute endometritis is diagnosed by the presence of more than 5 neutrophils in a 400 power field in the endometrial glands.
- Chronic endometritis is diagnosed by the presence of more than 1 plasma cell, (and lymphocytes)in a 120 power field in the endometrial stroma. Chronic (obstetric) endometritis usually occurs after delivery or termination of pregnancy, secondary to retained products of conception.
Usually non-obstetric causes are infections e.g. tuberculosis4, chlamydia, bacterial vaginosis and after intra-uterine contraceptive device fitting. There is usually a mix of 2-3 organisms involved, some will be found in normal vaginal flora. Chlamydia and Gonococcus are NOT common.5 Commonly found organisms include:
- Gram positive cocci - Staphylococcus spp., Streptococcus spp. (Peptostreptococcus, Group B streptococcus)
- Gram negative - E.Coli, Klebsiella spp., Proteus spp., Enterobacter spp., Gardnerella spp., Neisseria spp.
- Anaerobes - Bacteroides spp.
Risk factors
Obstetric risk factors
- Caesarean section (particularly if HIV positive6)
- Prolonged rupture of membranes
- Severe meconium staining in liquor7 - although this has been disputed8
- Long labour with multiple examinations
- Manual removal of placenta9
- Mothers age at extremes of reproductive span
- Low socio-economic status e.g. home delivery in poor hygiene environment10
- Maternal anaemia
- Prolonged surgery
- Internal fetal monitoring
- General anaesthetic
Non-obstetric risk factors
- Intra-uterine contraceptive device
- Absence of normal cervical mucus plug
- Menstrual fluid within cavity
- Instrumentation of the uterus
- Douching11
- Unprotected sexual intercourse
- Multiple sexual partners
Symptoms
Number and severity of symptoms can vary markedly from patient to patient, but usually include:
- Fever
- Abdominal pain
- Offensive smelling lochia
- Abnormal vaginal bleeding - postpartum haemorrhage
- Abnormal vaginal discharge
- Dyspareunia
- Dysuria
- General malaise
Signs
- Raised temperature
- Pain and tenderness, which may radiate to the adnexae
- Tachycardia
- Blood cultures are positive in 10-30%
- Check MSU
- High vaginal swab for gonorrhoea/chlamydia
There is nothing to be gained from ultrasound.12
Drugs
- Wound infection
- Peritonitis
- Adnexal infection
- Pelvic abscess
- Pelvic haematoma
90% of cases treated with antibiotics improve within 48-72 hours.14 If this is not the case, the patient should be re-evaluated.
Document References
- Ross JD; What is endometritis and does it require treatment? Sex Transm Infect. 2004 Aug;80(4):252-3.
- Bagratee JS, Moodley J, Kleinschmidt I, et al; A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. BJOG. 2001 Feb;108(2):143-8. [abstract]
- Andrews WW, Hauth JC, Cliver SP, et al; Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol. 2003 Jun;101(6):1183-9. [abstract]
- Gungorduk K, Ulker V, Sahbaz A, et al; Postmenopausal tuberculosis endometritis. Infect Dis Obstet Gynecol. 2007;2007:27028. Epub 2007 May 8. [abstract]
- Cicinelli E, De Ziegler D, Nicoletti R, et al; Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril. 2007 May 24;. [abstract]
- Louis J, Landon MB, Gersnoviez RJ, et al; Perioperative morbidity and mortality among human immunodeficiency virus infected women undergoing cesarean delivery. Obstet Gynecol. 2007 Aug;110(2 Pt 1):385-90. [abstract]
- Tran SH, Caughey AB, Musci TJ; Meconium-stained amniotic fluid is associated with puerperal infections. Am J Obstet Gynecol. 2003 Sep;189(3):746-50. [abstract]
- Panichkul S, Boonprasertmd K, Komolpismd S, et al; The association between meconium-stained amniotic fluid and chorioamnionitis or endometritis. J Med Assoc Thai. 2007 Mar;90(3):442-7. [abstract]
- Dehbashi S, Honarvar M, Fardi FH; Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding. Int J Gynaecol Obstet. 2004 Jul;86(1):12-5. [abstract]
- Maharaj D; Puerperal pyrexia: a review. Part I. Obstet Gynecol Surv. 2007 Jun;62(6):393-9. [abstract]
- Ness RB, Soper DE, Holley RL, et al; Douching and endometritis: results from the PID evaluation and clinical health (PEACH) study. Sex Transm Dis. 2001 Apr;28(4):240-5. [abstract]
- Mulic-Lutvica A, Axelsson O; Postpartum ultrasound in women with postpartum endometritis, after cesarean section and after manual evacuation of the placenta. Acta Obstet Gynecol Scand. 2007;86(2):210-7. [abstract]
- French L; Prevention and treatment of postpartum endometritis.; Curr Womens Health Rep. 2003 Aug;3(4):274-9. [abstract]
- French LM, Smaill FM; Antibiotic regimens for endometritis after delivery.; Cochrane Database Syst Rev. 2004 Oct 18;(4):CD001067. [abstract]
DocID: 2098
Document Version: 20
DocRef: bgp24659
Last Updated: 1 Sep 2007
Review Date: 31 Aug 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)

Books related to this topic (^ top of page)

Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
