1887

Chapter 5 : Postpartum Endometritis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in
Zoomout

Postpartum Endometritis, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555818210/9781555811327_Chap05-1.gif /docserver/preview/fulltext/10.1128/9781555818210/9781555811327_Chap05-2.gif

Abstract:

This chapter focuses on postpartum endometritis, especially the role of sexually transmitted organisms or syndromes and the adverse effects of these infections on the reproductive health of young women. Bacteremia is complicated by septic shock in 20 to 50% of medical and surgical patients compared to 0 to 12% of obstetric patients. The mortality rate among endometritis patients with bacteremia ranges from 0 to 4.3%; if septic shock occurs, mortality ranges from 0 to 67%. A large number of risk factors for postpartum endometritis, including labor, rupture of membranes, number of vaginal examinations, use of an internal fetal monitor, low parity, general anesthesia, skill of the surgeons, duration of surgery (>60 min), estimated blood loss (>500 ml), postoperative anemia, positive amniotic fluid culture, vaginal or cervical colonization with a variety of microorganisms including sexually transmitted organisms, absence of amniotic fluid-inhibiting factor(s), failure for labor to progress, and delivery by cesarean section, are evaluated. The use of internal fetal monitoring has been accompanied by concerns about increased intrauterine infection both pre- and postdelivery. The presence of virulent bacteria, including genital mycoplasmas, in the amniotic fluid is a significant risk factor for the development of postpartum endometritis, especially post-cesarean section. The use of antibiotic prophylaxis immediately after cord clamping has been demonstrated to dramatically reduce the incidence of postpartum endometritis following cesarean section. Bacterial vaginosis is a vaginal condition associated with increased concentrations of anaerobic bacteria and .

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

References

/content/book/10.1128/9781555818210.chap5
1. Blanco, J. D.,, R. S. Gibbs,, and Y. S. Castaneda. 1981. Bacteremia in obstetrics clinical course. Obstet. Gynecol. 58:621625.
2. Blanco, J. D.,, R. S. Gibbs,, and H. Malherber. 1983. A controlled study of genital mycoplasmas in amniotic fluid from patients with intra-amniotic infection. J. Infect. Dis. 147:650653.
3. Bryan, C. S.,, K. L. Reynolds,, and E. E. Moore. 1984. Bacteremia in obstetrics and gynecology. Obstet. Gynecol. 64:155158.
4. Chang, P. L.,, and E. R. Newton. 1992. Predictors of antibiotic in post cesarean endometritis. Obstet. Gynecol. 80:117122.
5. Chow, A. W.,, and L. B. Guze. 1974. Bacteroidaceae bacteremia: clinical experience with 112 patients. Medicine 53:9399.
6. D’Angelo, L. J.,, and R. J. Sokol. 1980. Time-related peripartum determinants of postpatum morbidity. Obstet. Gynecol. 55:319323.
7. DiZerega, G.,, L. R. Yonekura,, R. M. Nakamura,, and W. J. Ledger. 1979. A comparison of clindamycin-gentamicin and penicillin-gentamicin in the treatment of post cesarean endometritis. Am. J. Obstet. Gynecol. 134:238242.
8. Duff, P. 1980. Pathophysiology and management of septic shock. J. Reprod. Med. 24: 109117.
9. Duff, P.,, R. Gibbs,, J. Blanco,, and P. J. St. Clair. 1983. Endometrial culture techniques in puerperal patients. Obstet. Gynecol. 61:217222.
10. Eschenbach, D. A. 1993. Bacterial vaginosis and anaerobes in obstetric-gynecologic infection. Clin. Infect. Dis. 16(Suppl. 4):282287.
11. Eschenbach, D. A.,, M. G. Gravett,, and C. S. Chen. 1984. Bacterial vaginosis during pregnancy: an association with prematurity and postpartum complication. Scand. J. Urol. Nephrol. 86(Suppl.):213222.
12. Eschenbach, D. A.,, K. Rosene,, L. S. Tompkins,, H. Watkins,, and M. G. Gravett. 1986. Endometrial cultures obtained by a triple-lumen method from afebrile and febrile postpartum women. J. Infect. Dis. 153:10381045.
13. Faro, S. 1981. Group B beta hemolytic streptococci and puerperal infections. Am. J. Obstet. Gynecol. 139:686689.
14. Gabel, H. D. 1987. Maternal mortality in South Carolina from 1970 to 1984: an analysis. Obstet. Gynecol. 69:307311.
15. Gall, S. A.,, and G. B. Hill. 1980. High-dose cefamandole therapy in obstetric and gynecologic infections. Am. J. Obstet. Gynecol. 137:914.
16. Gassner, C. B.,, and W. J. Ledger. 1976. The relationship of hospital-acquired maternal infection to invasive intrapartum monitoring techniques. Am. J. Obstet. Gynecol. 126:33.
17. Gibbs, R. S. 1985. Infection after cesarean section. Clin. Obstet. Gynecol. 28:697707.
18. Gibbs, R. S.,, and J. D. Blanco. 1981. Streptococcal infections in pregnancy. A study of 48 bacteremias. Am. J. Obstet. Gynecol. 140:405411.
19. Gibbs, R. S.,, P. M. Jones,, and C. J. Wilder. 1978. Antibiotic therapy of endometritis following cesarean section. Obstet. Gynecol. 52:3137.
20. Gilstrap, L. C.,, and F. G. Cunningham. 1979. The bacterial pathogenesis of infection following cesarean section. Obstet. Gynecol. 53:545549.
21. Hager, D. 1975. Maternal febrile morbidity associated with fetal monitoring and cesarean section. Obstet. Gynecol. 46:260262.
22. Hagglund, L. K.,, K. Christensen,, P. Christensen,, and C. Kamme. 1983. Risk factors in cesarean section infection. Obstet. Gynecol. 62:145150.
23. Harrison, H. R.,, E. R. Alexander,, L. Weinstein,, M. Lewis,, M. Nash,, and D. A. Sim. 1983. Cervical Chlamydia trachomatis and mycoplasma infection in pregnancy: epidemiology and outcome. JAMA 250:17211727.
24. Hawrylyshyn, P. A.,, P. Bernstein,, and F. R. Papsin. 1981. Risk factors associated with infection following cesarean section. Am. J. Obstet. Gynecol. 139:294297.
25. Heggie, A. D.,, C. G. Lumicao,, L. A. Stuart,, and M. T. Gyues. 1981. Chlamydia trachomatis infection in mothers and infants. A prospective study. Am. J. Dis. Child. 135:507511.
26. Hurry, D. J.,, B. Larsen,, and D. Charles. 1984. Effects of post cesarean section febrile morbidity on subsequent fertility. Obstet. Gynecol. 64:256260.
27. Knuppel, R.,, J. Scerbo,, and J. Dzink. 1981. Quantitative transcervical uterine cultures with a new device. Obstet. Gynecol. 57:243248.
28. Lamey, J. R.,, D. A. Eschenbach,, S. H. Mitchell,, J. M. Blumhagen,, H. M. Foy,, and G. E. Kenny. 1982. Isolation of mycoplasmas and bacteria from the blood of post-partum women. Am. J. Obstet. Gynecol. 143:104111.
29. Ledger, W. J.,, M. Norman,, C. Gee,, and W. Lewis. 1975. Bacteremia on an obstetric-gynecologic service. Am. J. Obstet. Gynecol. 121:205212.
30. McCormack, W. M.,, Y.-H. Lee,, J.-S. L. Lin,, and J. S. Rankin. 1973. Genital mycoplasmas in postpartum fever. J. Infect. Dis. 127:193196.
31. Minkoff, H. L.,, M. F. Sierra,, G. F. Pringle,, and R. H. Schwarz. 1982. Vaginal colonization with group B beta-hemolytic streptococcus as a risk factor for post cesarean section febrile morbidity. Am. J. Obstet. Gynecol. 142:992995.
32. Monga, M.,, and B. T. Oshiro. 1993. Puerperal infections. Semin. Perinatol. 17:426431.
33. Mordhorst, C. H.,, and C. Dawson. 1971. Sequelae of neonatal inclusion conjunctivitis and associated disease in parents. Am. J. Ophthalmol. 71:861867.
34. Morrison, R. P.,, R. J. Belland,, K. Lyng,, and H. D. Caldwell. 1989. Chlamydia disease pathogenesis. The 57 KD chlamydial hypersensitivity antigen is a stress response protein. J. Exp. Med. 170:12711283.
35. Newton, E. R.,, T. J. Prihoda,, and R. S. Gibbs. 1990. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet. Gynecol. 75:402406.
36. Pass, M. A.,, B. M. Gray,, and H. C. Dillon, Jr. 1982. Puerperal and perinatal infections with Group B streptococci. Am. J. Obstet. Gynecol. 143:147152.
37. Patton, D. L.,, Y. T. C. Sweeney,, and C.-C. Kuo. 1994. Demonstration of delayed hypersensitivity in Chlamydia trachomatis salpingitis in monkeys: a pathogenic mechanism of tubal damage. J. Infect. Dis. 169:680683.
38. Platt, R.,, J.-S. L. Lin,, J. W. Warren,, B. Rosner,, K. C. Edelin,, and W. M. McCormack. 1980. Infection with Mycoplasma hominis in postpartum fever. Lancet :ii12171221.
39. Plummer, F. A.,, M. Laga,, R. C. Brunham,, P. Piot,, A. R. Ronald,, V. Bhullar,, J. Y. Mati,, A. Ndinya,, M. Cheang,, and H. Nsanze. 1987. Postpartum upper genital tract infections in Nairobi, Kenya. Epidemiology, etiology and risk factors. J. Infect. Dis. 156:9297.
40. Rehu, M.,, and C. G. Nilsson. 1980. Risk factors for febrile morbidity associated with cesarean section. Obstet. Gynecol. 56:269273.
41. Rosene, K.,, D. A. Eschenbach,, L. S. Tompkins,, G. E. Kenny,, and H. Watkins. 1986. Polymicrobial early postpartum endometritis with facultative and anaerobic bacteria, genital mycoplasmas and Chlamydia trachomatis: treatment with piperacillin or cefoxitin. J. Infect. Dis. 153:10281037.
42. Swartz, W. H.,, and K. Grolle. 1981. The use of prophylactic antibiotics in cesarean section: a review of the literature. J. Reprod. Med. 26:595609.
43. Sweet, R. L. 1981. Treatment of mixed aerobic-anaerobic infections of the female genital tract. J. Antimicrob. Chemother. 8(Suppl. D):105114.
44. Sweet, R. L.,, and R. L. Gibbs. 1995. Infectious Diseases of the Female Genital Tract. The Williams & Wilkins Co., Baltimore, Md.
45. Sweet, R. L.,, and W. J. Ledger. 1973. Puerperal infectious morbidity: a two year review. Am. J. Obstet. Gynecol. 117:10931100.
46. Sweet, R. L.,, and W. J. Ledger. 1979. Cefoxitin: single-agent treatment of mixed aerobic-anaerobic pelvic infection. Obstet. Gynecol. 54:193198.
47. Sweet, R. L.,, J. Schachter,, and M. O. Robbie. 1983. Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis from the endometrium in patients with acute salpingitis despite apparent clinical cure. JAMA 250:26412645.
48. Sweet, R. L.,, D. V. Landers,, C. Walker,, and J. Schachter. 1987. Chlamydia trachomatis infection and pregnancy outcome. Am. J. Obstet. Gynecol. 156:824830.
49. Thygeson, P.,, and W. J. Stone. 1942. Epidemiology of inclusion conjunctivitis. Arch. Ophthalmol. 27:91122.
50. Toth, M.,, A. Chaudry,, W. J. Ledger,, and S. S. Witkin. 1993. Pregnancy outcome following pelvic infection. Infect. Dis. Obstet. Gynecol. 1:1215.
51. Valenzuala, G. 1984. Fertility following cesarean section endoparametritis. Am. J. Obstet. Gynecol. 149:231232.
52. Wager, G. P.,, D. H. Martin,, L. Koutsky,, D. A. Eschenbach,, J. R. Daling,, E. R. Alexander,, and K. K. Holmes. 1980. Puerperal infectious morbidity relationship to route of delivery and to antepartum Chlamydia trachomatis infection. Am. J. Obstet. Gynecol. 138:10281033.
53. Walmer, D.,, K. Walmer,, and R. S. Gibbs. 1988. Enterococci in post cesarean endometritis. Obstet. Gynecol. 71:159161.
54. Watts, D. H.,, M. J. Krohn,, S. L. Hillier,, and D. A. Eschenbach. 1990. Bacterial vaginosis as a risk factor for post cesarean endometritis. Obstet. Gynecol. 75:5258.
55. Weinstein, M. P.,, J. R. Murphy,, L. B. Reller,, and K. A. Lichenstein. 1983. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. Rev. Infect. Dis. 5:5459.
56. Williams, C. M.,, D. M. Okada,, J. R. Marshall,, and A. W. Chow. 1987. Clinical and microbiologic risk evaluation for post cesarean section endometritis by multivariate discriminant analysis: role of intraoperative mycoplasma, aerobes, and anaerobes. Am. J. Obstet. Gynecol. 156:967974.

Tables

Generic image for table
Table 1

Causes of postpartum infection

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 2

Incidence of bacteremia in association with endometritis

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 3

Incidence of bacteremia in group B streptococcal puerperal infection

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 4

Bacteremia, septic shock, and mortality in obstetrical and gynecologic infections

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 5

Risk factors for postpartum endomyometritis

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 6

Microbiology of postpartum endomyometritis

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 7

Isolates obtained from the endometrial cavity with a triple-lumen catheter in 51 patients with postpartum endometritis

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5
Generic image for table
Table 8

Risk of postpartum upper genital tract infection in women with gonococcal and/or chlamydial infection of the cervix

Citation: Sweet R. 1999. Postpartum Endometritis, p 69-86. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch5

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error