eMedicine Specialties > Obstetrics and Gynecology > General Obstetrics

Endometritis: Differential Diagnoses & Workup

Author: Gema T Simmons, MD, Consulting Staff, Department of Obstetrics and Gynecology, Alegent Health
Contributor Information and Disclosures

Updated: Aug 2, 2009

Differential Diagnoses

Appendicitis
Pelvic Inflammatory Disease

Other Problems to Be Considered

Pyelonephritis
Viral syndrome
Pelvic thrombophlebitis

Workup

Laboratory Studies

  • On complete blood count the finding of leukocytosis may be difficult to interpret, secondary to the physiologic leukocytosis of pregnancy.
  • Blood culture is positive in 10-30% of cases.
  • Urine culture should be ordered.
  • Endocervical cultures (or DNA probe) are obtained for gonorrhea and chlamydia.
  • Culture of the endometrial cavity usually results in contamination from normal resident cervicovaginal flora.

Imaging Studies

  • Perform imaging studies on patients who do not respond to adequate antimicrobial therapy in 48-72 hours.
  • CT scanning of the abdomen and pelvis may be helpful for excluding broad ligament masses, septic pelvic thrombophlebitis, ovarian vein thrombosis, and phlegmon.
  • Sonographic findings of the abdomen and pelvis may be normal in patients with a clinical diagnosis of endometritis. Abnormal findings overlap with those of retained products of conception and intrauterine hematoma.

Procedures

Endometrial biopsy can be obtained to assess chronic endometritis in the nonobstetric population.

More on Endometritis

Overview: Endometritis
Differential Diagnoses & Workup: Endometritis
Treatment & Medication: Endometritis
Follow-up: Endometritis
References
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References

  1. Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol. May 2007;196(5):455.e1-5. [Medline].

  2. Tita AT, Hauth JC, Grimes A, Owen J, Stamm AM, Andrews WW. Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis. Obstet Gynecol. Jan 2008;111(1):51-6. [Medline].

  3. Tita AT, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol. Mar 2009;113(3):675-82. [Medline].

  4. Cunningham FG. Infection and disorders of the puerperium. In: Cunningham GF, MacDonald PC, Leven KJ, et al, eds. Williams Obstetrics. 20th ed. Stamford, Conn: Appleton & Lange; 1997:548-55.

  5. French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. 2004;CD001067. [Medline].

  6. Ledger WJ. Post-partum endomyometritis diagnosis and treatment: a review. J Obstet Gynaecol Res. Dec 2003;29(6):364-73. [Medline].

  7. Maharaj D. Puerperal pyrexia: a review. Part I. Obstet Gynecol Surv. Jun 2007;62(6):393-9. [Medline].

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Further Reading

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Keywords

metritis, endomyometritis, endomyoparametritis, myometritis, Cesarean delivery, C section, pelvic inflammatory disease, PID, retained products of conception, obstetric endometritis, nonobstetric endometritis, salpingitis, Ureaplasma urealyticum, Peptostreptococcus, Gardnerella vaginalis, Bacteroides bivius, group B Streptococcus, Chlamydia, Enterococcus, cesarean delivery, bacterial vaginosis

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Contributor Information and Disclosures

Author

Gema T Simmons, MD, Consulting Staff, Department of Obstetrics and Gynecology, Alegent Health
Gema T Simmons, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Anthony Charles Sciscione, DO, Director, Division of Maternal-Fetal Medicine, Professor, Department of Obstetrics and Gynecology, Drexel University College of Medicine
Anthony Charles Sciscione, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Antonio V Sison, MD, Medical Director, Ob/Gyn Group, Robert Wood Johnson University Hospital at Hamilton
Antonio V Sison, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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