see also: [[Chorioamnionitis]] > [!pearl] > - in post-partum woman with fever, consider pelvic infection until proven otherwise > - note that ==endometritis often co-exists with retained products of conception== > - Endometritis usually presents in first few days > - also consider DDx: retained products of conception, resp infection, pyelonephritis, mastitis, thrombophlebitis, c-section site infection, appendicitis, and complication of epidural eg epidural abscess ## Causative organisms - Gram +ve - GBS, GAS, staph, enterococcus - Gran -ve: e coli, proteus, klebsiella - anaerobic: bacteroides - others: mycoplasma, chlamydia ## Risk factors - prolonged labor / rupture of membranes - multiple vaginal examinations during labour - C-section ## Symptoms - secondary [[postpartum haemorrhage]] - foul smelling PV d/c ## Complications - parametrial phelgmons - surgical, incisional, pelvic abscess - infected haematoma - septic pelvic thrombophelbitis - nec fasc - peritonitis ## workup - need pelvic USS for retained products of conception - high vaginal swabs and swabs from c-section site if applicable - consider CT if pelvic abscess suspected - other sources of fever ## treatment non-severe can be treated with augmentin for 7 days most cases need to be admitted: - gent - metronidazole - amoxicillin clinda + gent is also an option if penicillin allergy