eMedicine Specialties > Obstetrics and Gynecology > General Obstetrics

Endometritis: Follow-up

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

Updated: Aug 2, 2009

Follow-up

Inpatient & Outpatient Medications

  • Patient may be discharged without antibiotic therapy after being afebrile for at least 24 hours and with a benign physical examination.
  • Further outpatient therapy has proved to be unnecessary.

Complications

Prognosis

  • Nearly 90% of women treated with an approved regimen note improvement in 48-72 hours.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Prophylactic antibiotics reduce the incidence of postpartum febrile morbidity in patients undergoing cesarean delivery. Current research supports the use of preoperative administration of prophylactic antibiotics. A recent joint publication by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) supports the administration of antibiotics prior to skin incision rather than immediately after cord clamping.
  • Single-agent cephalosporin therapy of the first- or second-generation type has been considered the best choice. However, current research is looking into extended-spectrum antibiotics with either azithromycin or metronidazole.2

Special Concerns

Current research is evaluating the timing of administration of cephalosporin prior to skin incision and giving extended-spectrum regimens with either azithromycin or metronidazole after cord clamp.1,2,3 Head-to-head comparisons between the 2 regimens still need to be done.3

Preoperative use of povidone-iodine vaginal preparation prior to cesarean delivery appears to decrease the incidence of postcesarean endometritis but does not seem to decrease the overall risk of postoperative fever or wound infection.

 


More on Endometritis

Overview: Endometritis
Differential Diagnoses & Workup: Endometritis
Treatment & Medication: Endometritis
Follow-up: Endometritis
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.