Postpartum endometritis is an infection of the lining of the womb which can occur up to six weeks after childbirth. It is much more common after caesarean section births. It usually causes a temperature, tummy pain and heavier vaginal bleeding. Postpartum endometritis needs prompt treatment with antibiotics.
What is postpartum endometritis?
Postpartum (postnatal) endometritis is an infection of the lining of the womb (uterus) that can occur in a mother after her baby has been delivered. 'Postpartum' or 'postnatal' means 'after the birth'. The endometrium is the inner lining of the womb, and in endometritis this lining becomes swollen and inflamed. This is caused by one or more germs (bacteria) getting into the womb during the process of childbirth.
When does postpartum endometritis occur?
Postpartum endometritis can occur any time up to six weeks after a baby has been born. It is most common between the second and tenth day after the delivery.
Who develops postpartum endometritis?
Postpartum endometritis only occurs in women who have recently had a baby. For other types of infection of the endometrium, see the separate leaflet called Pelvic Inflammatory Disease.
Postpartum endometritis occurs in 1-3 out of every 100 women who have had a normal (vaginal) delivery. It is much more common in women who have had a caesarean section. It occurs up to twenty times more often after a caesarean section than after a vaginal birth.
Other factors may make postpartum endometritis more likely. These risk factors include:
- Long labours, in particular your waters breaking (membranes breaking) a long time before the baby is born.
- The fluid around the baby (amniotic fluid) being stained with poo from the baby (meconium).
- Difficulty removing the afterbirth (placenta).
- Lots of internal examinations during labour.
- Infection in the genital area of the mother. For example:
- A past history of pelvic inflammatory disease (PID).
- Bacterial vaginosis (BV).
- Infection with Group B streptococcus.
- Obesity of the mother.
- Diabetes in the mother.
- Anaemia in the mother.
- Delivery in circumstances of poor hygiene. (This tends to be more common in lower-income countries.)
What are the symptoms of postpartum endometritis?
Symptoms of postpartum endometritis can vary. Common symptoms include:
- A high temperature (fever).
- Pain in the lower tummy area.
- A smelly discharge from the vagina.
- An increase in the bleeding from the vagina. It is normal to have some blood coming from the vagina for up to six weeks after delivery, but usually this gradually reduces. In postpartum endometritis, it may suddenly become heavier, or there may be blood clots where previously there were not.
- Pain on having sex.
- Pain on passing urine.
- Generally feeling unwell.
It can be difficult to tell what is normal and what is not after having a baby. Having some pain, bleeding and discharge is normal. However, if things seem to be changing or becoming worse, let your midwife or doctor know as soon as possible.
Are any tests needed?
Usually the diagnosis is assumed from the typical symptoms and signs in a woman who has just had a baby. Your pulse rate, blood pressure and temperature will be checked by your midwife or doctor. The midwife or doctor will feel your tummy and may do an internal vaginal examination. A blood test may be needed, or some swabs from the vagina. Your urine may also be tested for infection.
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. It is thought the best antibiotics to use for postpartum endometritis are two antibiotics called clindamycin and gentamicin together. These antibiotics are usually given by injection. However, there may be different regimes in different places, according to local guidelines.
Are there any complications of postpartum endometritis?
If not treated quickly, the infection can spread elsewhere in the body. At its worst, it can develop into sepsis, which is a widespread infection making you dangerously ill. It can also spread to a caesarean section wound, or inside the tummy area. Complications are rare when endometritis is treated with antibiotics.
What is the outlook for postpartum endometritis?
Most women with postpartum endometritis recover quickly with antibiotics. Usually within 2-3 days of starting the antibiotics, you will start to feel much better. Complications are rare.
Can postpartum endometritis be prevented?
It is known that having a caesarean section puts you at risk of postpartum endometritis. Therefore, before the operation in the UK, all women having a caesarean section are offered antibiotics to protect them. They are given into the vein before the operation starts. This makes the infection much less likely. Also before a caesarean section, your vagina may be cleaned with an antiseptic solution of povidone-iodine. This also helps to reduce the risk of infection afterwards.
Antibiotics before or during a normal (vaginal) delivery are not routinely used. You will, however, be offered antibiotics during labour if you have been found to have a germ called Group B streptococcus around your vagina. Antibiotics protect you and your newborn baby from infections caused by this germ.
Dr Sarah Jarvis, 12th April 2021
The National Institute for Health and Care Excellence (NICE) has issued new guidelines for healthcare professionals and the public about caesarean birth. Its recommendations for using antibiotics to reduce the risk of complications, including postpartum endometritis, have not changed. If you are having a caesarean section, you should be offered antibiotics immediately before your surgery starts - this can help protect against urinary tract and wound infections as well as endometritits.
Further reading and references
Bacterial Sepsis following Pregnancy; Royal College of Obstetricians and Gynaecologists (April 2012)
Caesarean birth; NICE Clinical Guideline (March 2021)
Mackeen AD, Packard RE, Ota E, et al; Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015 Feb 2(2):CD001067. doi: 10.1002/14651858.CD001067.pub3.
Smaill FM, Grivell RM; Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014 Oct 2810:CD007482. doi: 10.1002/14651858.CD007482.pub3.
Haas DM, Morgan S, Contreras K; Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev. 2014 Sep 9(9):CD007892. doi: 10.1002/14651858.CD007892.pub4.
Caesarean section; NICE Clinical Guideline (November 2011 - last updated September 2019)