I. Risk factors

  1. Age < 17y
  2. Cesarian delivery
  3. Preterm labor
  4. PROM
  5. Many vaginal exams
  6. Manual removal of placenta
  7. GBS colonization

II. Bugs: see Chorioamnionitis; GBS more likely if onset <48h post-partum

III. Clinical presentation: fever, uterine tenderness, foul lochia, & malaise; n.b. there is a normal leukocytosis post-partum so WBC not so useful

  1. In a retrospective series of 2108 women in Iowa (excluded those who got postpartum ABX unless for conditions other than endometritis), 3.3% had fever in 24h after birth; only 1.6 developed endometritis. Women who did not eventually develop endometritis developed fever earlier (4h vs. 30h postpartum!) and have lower temp (mean 38.2 vs. 38.9) (J. Fam. Prac. 43:146, 1996-JW)

IV. Complications: septic pelvic thrombophlebitis

  1. Occurs in 1-2% of cases of postpartum endometritis
  2. Us. ovarian vein, can extend to iliac or IVC
  3. Causes persistent fever despite ABX, tachycardia out of proportion to temp; sometimes can be dx'd on pelvic/abd CT; tx with ABX & heparin 7-10d

V. Tx: Broad-spectrum ABX, e.g. Amp/Gent/Clinda, Unasyn, etc.

(Sources: Karen Jones, 12/95; ACOG Tech. Bulletin #177, 2/93)