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Endometritis - infection of the lining of the

uterus

An infection of the lining of the uterus is called 'endometritis'. This type of infection may happen for
around 1 to 3 % of woman after a vaginal birth, and 10 to 30% of women after a Caesarean birth.
Other factors that can increase the likelihood of a uterine infection occurring can include the waters
being broken for more than 24 hours, a long labour, and multiple internal vaginal examinations during
the labour, retaining a part of the placenta or membranes in the uterus after the birth and interventions
such as forceps or ventouse. Women who are anaemic are also at increased risk, because their
resistance and immunity are lowered.

The signs of a uterine infection can include:

A fever (above 38o Celsius) and a rapid pulse (above 100 beats per minute).

Lower abdominal pain, with the uterus being tender to touch, when the belly is felt.

The vaginal blood loss smelling offensive, or looking like it has greenish, yellow pus mixed with it.

Possibly heavier bleeding.

Possibly a headache, sweats and 'the shakes' (known as 'rigors').

Uterine infections can be caused by hospital acquired bacteria, or bacteria the woman is already
carrying (such as gardnerella). However, it is often hard to pinpoint the actual bacteria causing the
infection, because of the difficulty in taking a laboratory swab test of the inside of the uterus. It is
believed that most cases of endometritis are caused by a combination of different bacteria.

Endometritis can be divided into 2 types:

Early onset - Within 2 to 3 days of the birth. This is the most common type. OR

Late onset - From 3 to 5 days, up to 6 weeks after the birth. This may be due to a small section of
the placenta being left inside the uterus that slowly breaks down, and eventually causes a uterine
infection. This is less common.

The main health concerns of endometritis are that the infection can spread to the fallopian tubes
(affecting future fertility), and/or move into the abdomen and possibly the blood stream. About 10 to
20% of women with endometritis will develop an infection of the blood stream, called 'sepsis'. Sepsis
can be tested for by taking a blood sample, and sending it to the laboratory. It takes around 24 to 48
hours to find out if any bacteria 'grow' in the blood. Because sepsis can be a life-threatening
complication, antibiotics are usually given before these test results are available. If the uterine
infection is severe, the woman will usually need to stay in the hospital for an extra few days to have
the antibiotics and to monitor her health (or be re-admitted to the hospital for a few days, if the
infection was first noticed after going home).
The types of antibiotics typically used to treat uterine infections are clindamycin and gentamicin. They
are usually administered through a drip in the vein (or by injections). These antibiotics have become
more appropriate in recent years, as bacteria have become more resistant to the penicillin-based
medications.

It is now generally routine to give all women having a Caesarean, antibiotics in the first couple of days
after the birth, 'just in case' a uterine infection develops. This is known as 'prophylactic treatment', as it
'treats' a potential problem before it happens. This approach has shown to decrease the chances of a
woman developing an infection of the uterus after the operation, by around 50 to 75%.

If you develop an infection of the uterus it is important to rest as much as possible, eat nourishing
foods, and have help with caring for your baby.