Postpartum Endometritis: What is it? How is it treated?

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After giving birth to a beautiful baby by cesarean section two days ago, Alexis started to feel pain in her lower abdomen that was aggravated when her nurse checked in on her and pressed on her belly. Additionally, Alexis noticed that the vaginal discharge she experienced in this pregnancy was different than that of her last pregnancy. This time it was yellowish and had an odd smell. Lastly, Alexis’ temperature was elevated. The nurse tells Alexis that she may be experiencing the symptoms of postpartum endometritis.

What is postpartum endometritis?

Endometritis is inflammation of the inner lining of the uterus (the endometrium) usually caused by an infection. Postpartum endometritis usually occurs within two to seven days after giving birth. However, it can occur at any time up to six weeks postpartum. Additionally, in women who get endometritis after giving birth by cesarean section the infection usually becomes apparent within two days.

How do you get postpartum endometritis?

The female reproductive system is divided into two parts: the upper reproductive system and the lower genital tract. The lower genital tract consists of the vulva, vagina, and cervix. The upper reproductive system contains the uterus, fallopian tubes, and ovaries.

The lower genital tract is home to many species of bacteria that live in harmony with your body as part of the normal bacterial flora. Endometritis occurs when bacteria infects the uterus in the upper reproductive area. These bacteria can come from the lower genital tract.

When giving birth there are many opportunities for bacteria to invade the uterus and cause problems. Obviously, when the cervix opens and the mucus plug that serves to seal the cervix and keep the upper and lower reproductive tracts separate is shed, the pathway is cleared not only for baby to come out, but also for bacteria to ascend. Furthermore, if you have a cesarean section, there is an opportunity for other bacteria to invade the uterus as the uterus is exposed to the outside world when the baby is delivered.

What are the risk factors?

Risk factors for developing postpartum endometritis include prolonged labor, premature rupture of membranes, and placental tissue that may have been left behind in the uterus after childbirth or fetal tissue remaining in the uterus after an abortion. Perhaps the most important factor that greatly increases your risk for developing postpartum endometritis is having a cesarean section delivery.

Risk factors for developing postpartum endometritis include:

Further risk factors for endometritis in general include sexually transmitted infections (such as chlamydia or gonorrhea) or having a gynecologic procedure (such as insertion of IUD or hysteroscopy) that requires medical devices to be inserted into the uterus.

How do I know if I have it?

Symptoms of postpartum endometritis include high fever, lower abdominal tenderness, and pain in the belly. You may also notice that your lochia rubra (the normal vaginal discharge that occurs after giving birth) has turned yellowish, purulent (pus-containing), and has a foul odor. Other symptoms include painful urination and pain during sexual intercourse.

Symptoms of postpartum endometritis include:

  • High fever
  • Uterine tenderness
  • Abdominal pain
  • Lochia rubra turning yellowish with foul odor
  • Painful urination
  • Pain during intercourse

How is it treated?

Endometritis, whether postpartum or not, is treated with antibiotics. Your doctor will choose which antibiotics to use based on which bacteria are causing the infection. To reduce the risk of developing postpartum endometritis after a cesarean section, patients are given prophylactic antibiotics during the procedure. If the endometritis is the result of infection of retained fetal tissue, a procedure called dilatation and curettage (commonly referred to as a D & C) may be required, during which that tissue can be removed.

If the infection is not properly treated, it could spread to surrounding structures like the fallopian tubes or ovaries. The bacteria could also invade other parts of your body and may cause sepsis. Furthermore, chronic or long-term endometritis could lead to fibrous tissue growing in the uterus and infertility.

Is breastfeeding safe while undergoing treatment?

It is important to talk to your doctor about the safety of breastfeeding while you are being treated for postpartum endometritis, as this may depend on the particular antibiotics that are being used to treat this condition.

Janette DeFelice
Dr. Janette DeFelice is a writer currently focusing on how the changing environment affects our health. She holds a Doctor of Medicine degree from Chicago Medical School where she taught clinical and diagnostic skills to beginning medical students, and a Master’s degree in Humanities from the University of Chicago. She also has a Bachelor’s degree in Political Science. Her writing can be seen online at BeTheChangeMom, ChicagoNow, and Medium, and she’s very excited to have published her first novel, Delia Rising: A Ballet in Three Acts. She lives in Chicago’s west suburbs with her school-age twins, her husband, and a family cat named Clara Barton.

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