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Uterine Infection

Pathophysiology

The major predisposing clinical factor for pelvic infections is cesarean delivery The frequency and severity are greater after abdominal delivery than after vaginal delivery uterine infection, endomyometritis, endometritis. The incidence after vaginal delivery is only 1-3%, whereas the incidence after abdominal delivery is 5-10 times greater. Those patients who undergo elective cesarean section (with no labor and no rupture of membranes) have lower rates than do those who undergo emergency or nonelective procedures (with labor, rupture of membranes, or both) uterus.

Prolonged labor and premature ruptured membranes are the two most common risk factors associated with after cesarean birth. The number of vaginal examinations, socioeconomic status, and internal fetal monitoring have also been implicated.

Endometritis is a polymicrobial, with a mixture of aerobes and anaerobes. Aerobes include gram-negative bacilli (eg, E coli) and gram-positive cocci (eg, group B streptococci). Anaerobic organisms have major roles in after cesarean birth; they are found in 80% of specimens. The most common isolated organism is Bacteroides.

Clinical evaluation

The diagnosis of endometritis is based on the presence of fever and the absence of other causes of fever. Uterine tenderness, especially parametrial, and purulent or foul-smelling lochia are common.

Laboratory studies, with the exception of blood cultures, are usually not helpful.

Treatment

Clindamycin-gentamicin most effective regimen, a combination that is curative in 85-95% of patients.

Gentamicin 100 mg (2 mg/kg) IV load, then 100 mg (1.5 mg/kg) IV q8h.

Clindamycin, 600-900 mg IV q8h.

Treatment