Endometritis

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Postpartum Endometritis Evidence Based Paper
March 13, 2012

Endometritis is the inflammation or irritation of the uterus, which is a common post partum complication that occurs in more than 15% of all pregnancies and is currently the leading cause of maternal mortality (Scott & Hasik, 2001). When endometritis is not related to pregnancy, it is referred to as pelvic inflammatory disease (PID). The Centers for Disease Control and Prevention (CDC) 2010 sexually transmitted diseases treatment guideline defines PID as any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. From a pathologic perspective, endometritis can be classified as acute versus chronic. Acute endometritis is distinguished by the presence of neutrophils within the endometrial glands. Chronic endometritis is characterized by the presence of plasma cells and lymphocytes within the endometrial stroma. Chronic endometritis in the postpartum or post abortion patient is usually associated with retained products of conception after delivery or abortion. In the nonobstetric population, chronic endometritis has been associated with infections such as chlamydia, tuberculosis, bacterial vaginosis, and the presence of intrauterine devices (Rivlin, 2011). Early-onset postpartum endometritis occurs within two days of delivery, and the late-onset of the disease can occur up to six weeks postpartum. This condition will usually start as a local infection at the placental attachment site and if left untreated, can spread to the entire uterine endometrium (French & Smaill, 2004). There are numerous risks associated with this condition, and diagnosis relies heavily on the clinical judgment of the practitioner. The contamination of the uterine cavity with vaginal organisms during labor and delivery causes the disease. Both bacterial and viral infections may initiate endometritis and many of the agents that cause the infection are naturally present in the vagina. This condition arises commonly after delivery because delivery results in tears, rips or incisions in the vagina, cervix or uterus that allow these agents to enter the uterine lining. The infection can have several species of causative agents that can be aerobic or anaerobic flora (French & Smaill, 2004). The method of delivery will determine which causative agents prognosticate the possibility of endometritis. For vaginal deliveries, the presence of the organisms associated with bacterial vaginosis or genital cultures positive for aerobic gram-negative organisms can indicate endometritis. In cesarean births, the occurrence of certain bacteria such as group A hemolytic streptococci, staphylococci B, Neisseria gonorrhoeae, or Mycoplasma hominis in amniotic fluid cultures will put the patient at an increased risk for this infection (French & Smaill, 2004). With the increasing number of people opting for natural birth methods, including water births, the danger only multiplies. This is because disinfecting procedures as they are carried out before major surgery is usually not practiced in a home environment. Prompt treatment is essential to prevent the spread of the infection through other areas of the body, including the blood. Prolonged infection can be fatal. The immediate postpartum period following birth is a time of increased risk for all women for infection. Microorganisms entering the reproductive tract and migrating into the blood and other parts of the body could result in life threatening septicemia (French & Smaill, 2004). Timely diagnosis and aggressive treatment is essential to prevent these complications. Complications of endometritis include infertility, extension of infection to involve the peritoneal cavity with peritonitis, intra-abdominal abscess, and septic pelvic thrombophelbitis. Septic pelvic thrombophelbitis is a condition in which blood clots in one of the pelvic vessels become infected. If untreated it could progress to septic...
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