Treatment For Postpartum
Postpartum period
A postpartum period begins immediately after the birth of a child as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium or puerperal period, or immediate postpartum period are commonly used to refer to the first six weeks foll…
What is postpartum endometritis and how is it treated?
Postpartum endometritis is a bacterial infection some women develop after childbirth. The infection usually affects the inner lining of the uterus (endometrium) ( 1 ). Though postpartum endometriosis isn’t a serious health condition, it often requires antibiotic therapy to avert complications.
Which medications are used to treat endometritis after cesarean birth?
oral ofloxacin plus intravenous clindamycin versus intravenous clindamycin and intravenous gentamicin. Twenty studies enrolled only postpartum women who developed endometritis after cesarean birth; in four studies, the mode of delivery was not reported. In the remainder, a variable proportion of cases followed cesarean birth.
Should aminoglycosides be used in the clinical setting of postpartum endometritis?
Although the studies included in this review did not collect information systematically on renal toxicity, there is no evidence that using an aminoglycoside in the clinical setting of postpartum endometritis should not be recommended because of toxicity.
What should be included in a patient education about endometritis?
Review the treatment and management options available for patients with endometritis. Summarize interprofessional team strategies for improving care coordination and communication to better diagnose and treat endometritis. Access free multiple choice questions on this topic.
What is the treatment for postpartum endometritis?
Postpartum endometritis is treated with antibiotics. If you are well in yourself, and the infection is mild, you may be treated with antibiotic tablets at home. However, many women are admitted to hospital for antibiotics to be given into a vein (intravenous antibiotics) in order to treat the infection quickly.
What is the best treatment for endometritis?
Endometritis usually goes away with antibiotics without any further problems. However, problems with reproduction and severe infections can occur if the condition isn't treated. These can lead to infertility or septic shock.
How is endometritis treated in pregnancy?
Surgery and hormonal therapy, the standard treatments for endometriosis, are generally not recommended while pregnant. Over-the-counter pain relievers may help reduce endometriosis discomfort, but it's important to work with your doctor to determine which ones can be safely used during pregnancy, and for how long.
What antibiotics treat postpartum endometritis?
Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.
How do you prevent postpartum endometritis?
When delivery is cesarean, prophylactic antibiotics given within 60 minutes before surgery can reduce risk of endometritis by up to 75%.
Can endometritis be treated?
Most cases of endometritis, including those following cesarean delivery, should be treated in an inpatient setting. For mild cases following vaginal delivery, oral antibiotics in an outpatient setting may be adequate.
What causes postpartum endometritis?
Postpartum endometritis is a bacterial infection, so it is caused by the infiltration of bacteria into the inner lining of the womb. The bacteria typically migrates into the endometrium during the labor and delivery process and grows into a full-blown infection in the following days or weeks.
How does doxycycline help endometritis?
Doxycycline inhibits MMP enzymes which are important in regulating organ development. MMP levels were increased in endometriosis tissue compared to normal tissue. When the researchers treated endometriosis cells collected from patients with doxycycline, the number of cells decreased by up to 78%.
Does doxycycline treat endometritis?
Generally, the drug of choice is doxycycline, administered in doses of 100 mg every 12 hours for 14 days, or alternatively, the administration of cephalosporins, macrolides, or quinolones is possible. It is preferable for the partner to also undergo the same antibiotic treatment.
Is metronidazole used for endometritis?
Up to 30% to 50% of women with endometriosis may experience infertility. Using mice with surgically induced endometriosis, the researchers found that treatment with metronidazole reduced the size of lesions related to endometriosis in the gut of the animals.
Can you take ampicillin and metronidazole together?
No interactions were found between ampicillin and Flagyl.
Does azithromycin treat endometritis?
Azithromycin in the Treatment of Preterm Prelabor Rupture of Membranes Demonstrates a Lower Risk of Chorioamnionitis and Postpartum Endometritis with an Equivalent Latency Period Compared with Erythromycin Antibiotic Regimens.
Etiology of Postpartum Endometritis
Endometritis may develop after chorioamnionitis during labor or postpartum. Predisposing conditions include
Symptoms and Signs of Postpartum Endometritis
Typically, the first symptoms of postpartum endometritis are lower abdominal pain and uterine tenderness, followed by fever—most commonly within the first 24 to 72 hours postpartum. Chills, headache, malaise, and anorexia are common. Sometimes the only symptom is a low-grade fever.
Diagnosis of Postpartum Endometritis
If adequate treatment of postpartum endometritis does not result in a downward trend in peak temperature after 48 to 72 hours, consider pelvic abscess and, particularly if no abscess is evident on scans, septic pelvic thrombophlebitis.
Treatment of Postpartum Endometritis
Treatment of postpartum endometritis is a broad-spectrum antibiotic regimen given IV until women are afebrile for 48 hours.
Prevention of Postpartum Endometritis
Preventing or minimizing predisposing factors is essential. Vaginal delivery cannot be sterile, but aseptic techniques are used.
Key Points
Postpartum endometritis is more common after cesarean delivery, particularly if unscheduled.
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What is postpartum endometritis?
Postpartum endometritis is an infection of the uterus lining or upper genital tract that some women develop following childbirth. The term "postpartum" refers to the period of the time right after childbirth and "endometritis" is a reference to the location of the infection in the endometrium. The endometrium is the interior wall of the uterus.
How does postpartum endometritis develop?
Postpartum endometritis is a bacterial infection, so it is caused by the infiltration of bacteria into the inner lining of the womb. The bacteria typically migrates into the endometrium during the labor and delivery process and grows into a full-blown infection in the following days or weeks. Postpartum endometritis infections usually develop ...
What is the incidence rate of postpartum endometritis after delivery?
After a regular, vaginal delivery, the reported incidence rate of postpartum endometritis is about 1-3% . The incidence rate for postpartum endometritis is 5-10 times higher after a C-section delivery. This makes a C-section delivery the primary risk factor for this condition.
What is the most common pathogen for postpartum endometritis?
Postpartum endometritis can be caused by any type of bacterial, but the most common pathogens involved in this infection are group B streptococci and staphylococcus (staph). Postpartum endometritis is much more common after a C-section delivery compared to a normal vaginal delivery.
What happens if a mother has an infection during pregnancy?
Maternal Infection: if the mother develops an infection during pregnancy (or has an active infection when she goes into labor) she is more likely to develop postpartum endometritis.
Why do doctors remove the placenta?
The second is the doctor can take her hand and form a cleavage plane between the placenta and the wall of the uterus. The latter is called manual removal of the placenta. This increases the likelihood of postpartum endometritis. Why? Because you are breaking up blood vessels. This causes more raw surfaces to emerge which are breeding grounds for preexisting bacteria in the endometrial cavity.
Can you take antibiotics for postpartum endometritis?
Most cases of postpartum endometritis can be effectively treated with basic antibiotics that you take at home. The 2nd generation antibiotic clindamycin is usually prescribed in combination with another type of antibiotic (usually gentamicin ). These are often given by injection in an outpatient setting. In some cases, women with postpartum endometritis may be treated in a hospital setting and given antibiotics intravenously.
Which is the most effective treatment for endometritis after childbirth?
The results showed that the combination of intravenous gentamicin and clindamycin, and drugs with a broad range of activity against the relevant penicillin‐resistant bacterial strains, are the most effective for treating endometritis after childbirth. Women treated with clindamycin plus an aminoglycoside (gentamicin) showed fewer treatment failures than those treated with penicillin, but this difference was not evident when women treated with clindamycin plus an aminoglycoside were compared to women who received other antibiotic treatments.
What causes postpartum endometritis?
Postpartum endometritis occurs when vaginal organisms invade the endometrial cavity during the labor process and cause infection . This is more common following cesarean birth. The condition warrants antibiotic treatment.
How long does it take for antibiotics to work on endometritis?
Treatment is usually considered successful after the woman is afebrile for 24 to 48 hours. The spectrum of activity of clindamycin with gentamicin makes these antibiotics a popular choice for initial therapy and this combination is widely considered as the gold standard (Monga 1993). However, alternative treatment regimens for endometritis with different antimicrobial activity or pharmacokinetic profiles may be associated with differences in clinical effectiveness, side‐effects or cost.
What causes a fever in the vagina after birth?
Endometritis causes fever, tenderness in the pelvic region and unpleasant‐smelling vaginal discharge after the birth. It can have serious complications such as the formation of pelvic abscesses, blood clots, infection of the thin layer of tissue that covers the inside of the abdomen and abdominal organs (peritonitis), and whole body inflammation (sepsis). It is also an important cause of maternal deaths worldwide, although with the use of antibiotics, this is very rare in high‐income countries.
How long does it take for endometritis to occur?
Inflammation of the lining of the womb (endometritis) can be caused by vaginal bacteria entering the womb (uterus) during childbirth and causing infection within six weeks of the birth (postpartum endometritis). Postpartum endometritis occurs after about 1% to 3% of vaginal births, and up to 27% of cesarean births. Prolonged rupture of the membranes (breaking the bag of water that surrounds the baby) and multiple vaginal examinations during birth also appear to increase the risk.
What are the complications of endometritis?
Complications of endometritis include extension of infection to involve the peritoneal cavity with peritonitis, intra‐abdominal abscess, or sepsis. Septic pelvic thrombophlebitis, which can be associated with septic pulmonary emboli, can occur rarely as a complication of postpartum endometritis.
What is the pathogenesis of endometritis?
The pathogenesis of endometritis is related to contamination of the uterine cavity with vaginal organisms during labor and birth and invasion of the myometrium. The presence of certain bacteria (e.g. groups A and B streptococci, aerobic Gram‐negative rods, Neisseria gonorrhoeae, Mycoplasma hominisand certain anaerobic bacteria) in amniotic fluid cultures at the time of cesarean birth is associated with an increased risk of postpartum endometritis (Newton 1990). For vaginal births, the presence of the organisms associated with bacterial vaginosis (e.g. certain anaerobic bacteria and Gardnerella vaginalis) or genital cultures positive for aerobic Gram‐negative organisms is associated with an increased risk for endometritis (Newton 1990). Prolonged rupture of membranes and multiple vaginal examinations have also been identified as potential risk factors (Gibbs 1980). Women with bacterial vaginosis in early pregnancy have three times significantly higher risk of postpartum endometritis (Jacobsson 2002).
Causes Of Postpartum Endometritis
Both aerobic and anaerobic bacteria can cause chronic endometritis. Some pathogens responsible for it are Clostridium, Staphylococcus, and Escherichia coli. Most of these bacteria enter the endometrial cavity through the genital tract during labor contractions and at the time of vaginal deliveries but more often during cesarean delivery.
Signs And Symptoms Of Postpartum Endometritis
The most common symptoms of postpartum endometritis include fever and discomfort or tenderness in the vaginal area. The other signs and symptoms of endometritis may include ( 1) ( 3 ).
Risk Factors For Postpartum Endometritis
The common risk factors for postpartum endometritis include ( 1) ( 3) ( 4 ).
Diagnosis Of Postpartum Endometritis
Postpartum endometritis is primarily diagnosed by observing the symptoms and conducting a thorough physical examination of the vaginal area. The doctor may suggest urine or blood tests, wet prep, or laparoscopy for further confirmation ( 1) ( 4 ).
Treatment For Postpartum Endometritis
Postpartum endometritis can be treated with oral antibiotics. Clinical findings suggest that the combination of clindamycin and gentamicin show positive results ( 5 ). Your doctor may also recommend ampicillin with other antibiotics.
Complications Of Postpartum Endometritis
According to the World Health Organization (WHO), women who have been exposed to bacteria causing chronic endometritis are prone to disabilities such as chronic pelvic pain, blockage in the fallopian tubes, and secondary infertility, leading to recurrent abortions ( 6 ).
Prevention Of Postpartum Endometritis
Studies have shown that prophylactic antibiotic therapy could reduce the chances of postpartum endometritis by around 60% ( 7 ). In addition, proper prenatal care before delivery helps reduce the risk of postpartum endometritis ( 3 ).
What is postpartum endometritis?
Your Care Instructions. Postpartum endometritis is an infection of the lining of the uterus after you give birth. It is treated with antibiotics. It is very important to treat this problem. If you don't, you can get a more serious infection.
What to do if you have a vaginal bleeding?
Call your doctor or nurse call line now or seek immediate medical care if: You have severe vaginal bleeding. This means you are soaking through a pad each hour for 2 or more hours or passing blood clots. You are dizzy or light-headed, or you feel like you may faint. You are vomiting or cannot keep fluids down.
What is follow up care?
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
How to help belly pain?
If you have belly pain, use a hot water bottle. Or you can use a heating pad set on low. Put a thin cloth between the heating pad and your skin.