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Postpartum endometritis
Medical expert of the article
Last reviewed: 07.07.2025
Postpartum endometritis is an inflammation of the superficial layer of the endometrium. Endomiometritis (metroendometritis) is the spread of inflammation from the basal layer of the endometrium to the myometrium. Panmetritis is the spread of inflammation from the endometrium and myometrium to the serous layer of the uterus.
[ Symptoms of postpartum endometritis
The initial stage of postpartum endometritis may have different severity and have a polymorphic picture. It is necessary to distinguish between classical, latent and abortive forms of endometritis, as well as endometritis after cesarean section. The classical form of endometritis usually develops on the 3rd-5th day after childbirth. This form is characterized by fever, intoxication, mental changes, pronounced leukocytosis with a shift in the leukocyte formula to the left, pathological discharge from the uterus. With the latent form of endometritis, the disease usually develops on the 8th-9th day after childbirth, the body temperature is subfebrile, local manifestations are poorly expressed. The abortive form of endometritis proceeds like the classical one, but with a high level of immunological protection it quickly stops. Endometritis after cesarean section can be complicated by pelvic peritonitis, peritonitis, which develop on the 1st-2nd day after the operation.
Diagnosis of postpartum endometritis
Diagnosis of postpartum endometritis is based on:
- clinical data: complaints, anamnesis, clinical examination. During vaginal examination: the uterus is moderately sensitive; subinvolution of the uterus; purulent discharge;
- laboratory data: general blood test (leukogram), general urine test, bacteriological and bacterioscopic examination of discharge from the cervix and/or body of the uterus, blood and urine tests if necessary, immunogram, coagulogram, blood biochemistry;
- instrumental data: ultrasound.
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Treatment of postpartum endometritis
In most cases, treatment of postpartum endometritis is pharmacological, but surgical treatment is also possible.
Complex treatment of postpartum endometritis includes not only systemic antibacterial, infusion, detoxification therapy, but also local treatment. Antibiotic therapy can be empirical and targeted. Preference is given to targeted antibiotic therapy, which is possible with the use of accelerated methods of pathogen identification using the multimicrotest system. If fever continues for 48-72 hours after the start of treatment, resistance of the pathogen to the antibiotics used should be suspected. Treatment with intravenous antibiotics should be continued for 48 hours after the disappearance of hyperthermia and other symptoms. Tableted antibiotics should be prescribed for another 5 days.
It should be taken into account that antibiotics enter the mother's milk. The immature enzyme system of a breastfed baby may not cope with the complete elimination of antibiotics, which may lead to a cumulative effect. The degree of diffusion of an antibiotic into breast milk depends on the nature of the antibiotic.
Women who breastfeed can be prescribed the following antibiotics: penicillins, cephalosporins, the issue of macrolides (the literature provides contradictory data regarding erythromycin), aminoglycosides is decided individually. The following antibiotics are strictly contraindicated during breastfeeding: tetracyclines, fluoroquinolones, sulfonamides, metronidazole, tinidazole, clindamycin, imipenems.
Local therapy for endometritis is aspiration-washing drainage of the uterine cavity using a double-lumen catheter, through which the uterine walls are irrigated with antiseptic and antibiotic solutions. Cooled to 4 °C 0.02% chlorhexidine solution, isotonic sodium chloride solution at a rate of 10 ml / min. Contraindications to aspiration-washing drainage of the uterus are: failure of the sutures on the uterus after cesarean section, spread of infection beyond the uterus, as well as the first days (up to 3-4 days) of the postpartum period. If pathological inclusions (blood clots, remnants of fetal membranes) in the uterine cavity cannot be washed out by washing drainage, they must be removed by vacuum aspiration or careful curettage against the background of antibacterial therapy and normal body temperature. In the absence of such conditions, curettage is performed only for vital indications (bleeding in the presence of placental remnants).
Surgical treatment is resorted to in case of ineffectiveness of conservative therapy and in the presence of negative dynamics in the first 24-48 hours of treatment, with the development of SIRS. Surgical treatment of postpartum endometritis consists of laparotomy and extirpation of the uterus with fallopian tubes.
Proper treatment of postpartum endometritis is the basis for the prevention of common forms of infectious diseases in women in labor.