endometritis

Endometritis is inflammation of the endometrium, the inner lining of the uterus, usually caused by infection. It is categorized as acute or chronic. Acute endometritis often follows childbirth, abortion, or gynecologic procedures and is most commonly polymicrobial, involving aerobic and anaerobic bacteria. Chronic endometritis is a separate, less common condition characterized by persistent endometrial inflammation.

Causes and risk factors include postpartum infection after vaginal delivery or cesarean section, postabortal infection, intrauterine device use, recent gynecologic procedures, and retained products of conception. Other risk factors are prolonged rupture of membranes, prolonged labor, diabetes, obesity, immunosuppression, and nosocomial exposures. The condition may present with fever, uterine tenderness, lower abdominal pain, and foul-smelling lochia, particularly in the postpartum setting. Tachycardia and mild leukocytosis are common. Diagnosis is primarily clinical, supported by laboratory data. Blood cultures are not routinely diagnostic. Pelvic examination with uterine tone assessment and discharge inspection is typical; ultrasound or CT may be used to evaluate for retained tissue or pelvic collections. Endometrial sampling or cultures can be considered in unclear cases or when atypical organisms are suspected.

Microbiology is frequently polymicrobial, including Escherichia coli, Streptococcus species (e.g., Group A or Group B Streptococcus), Staphylococcus aureus, and anaerobes such as Bacteroides species. Treatment requires broad-spectrum antibiotics that cover aerobes and anaerobes. Common regimens include clindamycin plus gentamicin or ampicillin-sulbactam, with options like piperacillin-tazobactam. Duration typically ranges from 4 to 7 days, adjusted to clinical response. Surgical management is indicated for retained tissue, abscess, or sepsis. Prophylactic antibiotics during cesarean and strict asepsis reduce risk. Prognosis is favorable with prompt therapy, though complications such as sepsis or pelvic abscess can occur; chronic endometritis can contribute to infertility or recurrent pregnancy loss.