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Infections of the Uterus

by Julie S. Moldenhauer, MD

  • Bacteria can infect the uterus and surrounding areas soon after delivery.

  • Such infections commonly cause pain in the lower abdomen, fever, and a foul-smelling discharge.

  • Diagnosis is usually based on symptoms and results of a physical examination.

  • Antibiotics usually cure the infection.

Postpartum infections usually begin in the uterus. They may develop if the membranes containing the fetus (amniotic sac) are infected and cause a fever during labor. These infections include infection of the uterine lining (endometritis), uterine muscle (myometritis), or areas around the uterus (parametritis).

Causes

Bacteria that normally live in the healthy vagina can cause an infection after delivery. Conditions that make a woman more likely to develop an infection include the following:

  • Anemia

  • Bacterial vaginosis

  • Repeated vaginal examinations

  • Internal monitoring of the fetus (which requires rupture of the membranes)

  • A long delay (often more than 18 hours) between rupture of the membranes and delivery

  • Prolonged labor

  • Cesarean delivery

  • Placental fragments remaining in the uterus after delivery

  • Excessive bleeding after delivery (postpartum hemorrhage)

  • Young age

  • Low socioeconomic group

The chances of developing a uterine infection depend mainly on the type of delivery:

  • Normal vaginal deliveries: 1 to 3%

  • Caesarean deliveries that have been scheduled and are done before labor starts: 5 to 15%

  • Caesarean deliveries that are not scheduled and are done after labor starts: 15 to 20%

Symptoms

Symptoms commonly include pain in the lower abdomen or pelvis, fever (usually within 1 to 3 days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. The heart rate is often rapid. The uterus is swollen, tender, and soft. Typically, there is a malodorous discharge from the vagina, which varies in amount. But sometimes the only symptom is a low-grade fever.

When the tissues around the uterus are infected, they swell, causing significant discomfort. Women typically have severe pain and a high fever.

Some severe complications can occur but not often. They include the following:

  • Inflammation of the membranes that line the abdomen (peritonitis)

  • Blood clots in the pelvic veins (pelvic thrombophlebitis)

  • A blood clot that travels to the lung and blocks an artery there (pulmonary embolism)

  • High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis (a bodywide infection) or septic shock

  • A pocket of pus (abscess) in the pelvis

In sepsis and septic shock, blood pressure falls dramatically and the heart rate is very rapid. Severe kidney damage and even death may result. These complications are rare, especially when postpartum fever is diagnosed and treated promptly.

Diagnosis

An infection may be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have a fever and no other cause is identified.

Usually, doctors take a sample of urine and send it to be cultured and checked for bacteria.

Treatment

If the uterus is infected, women are usually given antibiotics (usually clindamycin plus gentamicin) intravenously until they have had no fever for at least 48 hours. Afterward, most women do not need to take antibiotics by mouth.

Before a cesarean delivery, doctors may give women antibiotics shortly before surgery. Such treatment can help prevent infections of the uterus and the areas around it.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CLEOCIN
  • GENOPTIC