Postpartum Endometritis

Q: 32 years old female is admitted to the ICU from the OB-GYN ward with septic shock, where she was admitted 24 hours ago for delivery. The risk of postpartum endometritis is higher with? - select one

A) cesarean birth

B) vaginal birth

Answer: A

Cesarean birth, particularly when performed after the onset of labor, is the most dominant risk factor for postpartum endometritis. The risk is lower with a scheduled C-section. Antibiotic prophylaxis plays an essential role in the prevention. When an emergent C-section is required, there may be a tendency to forgo antibiotic prophylaxis.

Other significant risk factors are:

• Chorioamnionitis
• Prolonged labor
• Prolonged rupture of membranes
• Multiple cervical examinations
• Internal fetal or uterine monitoring
• Large meconium in amniotic fluid
• Manual removal of the placenta
• Maternal diabetes mellitus
• Severe anemia
• Preterm or post-term birth
• Obesity
• HIV infection
• Colonization with group B Streptococcus 
• Nasal carriage of Staphylococcus aureus
• Heavy vaginal colonization by E. coli

#ob-gyn

#ID

References:

1. Faro S. Postpartum endometritis. Clin Perinatol. 2005 Sep;32(3):803-14. doi: 10.1016/j.clp.2005.04.005. PMID: 16085035.

2. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014; :CD007482.

3. Martikaitytė J, Bartulevičienė A, Paliulytė V, Dasevičius D, Ramašauskaitė D. Postpartum Endometritis and Sepsis Associated with Gardnerella vaginalis and Anaerococcus tetradius: Case Report and Literature Review. Reports (MDPI). 2025 Aug 10;8(3):143. doi: 10.3390/reports8030143. PMID: 40843885; PMCID: PMC12371980.