POSTPARTUM ENDOMETRITIS (Part 2)

Last week, we started a topic on Postpartum Endometritis. We defined and discussed the causes and symptoms. This week, we conclude with diagnosis, treatment, and prevention of postpartum endometritis.

DIAGNOSIS OF POSTPARTUM ENDOMETRITIS

• Medical History and Physical Examination:  The patient is asked about their symptoms and medical background.  A physical examination, which will include abdominal check, to look for infection-related symptoms such as uterine pain, and unusual vaginal discharge is done.

• Pelvic Examination:  This is carried out to ascertain the uterus’ size, shape, and discomfort. A speculum could be used by the doctor to inspect the cervix and collect tissue samples for further analysis.

• Vaginal and Cervical Cultures: In order to pinpoint the precise bacterium causing the infection, cultures may be collected from the vaginal discharge or cervix. This aids in choosing the most efficient antibiotic course of action.

• Imaging examinations: In some circumstances, imaging examinations like ultrasound may be carried out to assess the uterus and surrounding structures for any problems or the development of an abscess.

• Endometrial biopsy: An endometrial biopsy may be performed where the diagnosis is unclear. This is used to establish the presence of an infection and rule out other possible causes of symptoms. A tiny sample of the uterine lining is removed and subjected to microscopic analysis.

• Blood Tests:  This  can be used to check for infection-related indicators such as raised levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell count (leukocytosis). These tests can support the diagnosis of infection and inflammation in the body

TREATMENT OF POSTPARTUM ENDOMETRITIS

• Antibiotic Therapy:  The most prevalent bacteria that cause postpartum endometritis are often targeted by broad-spectrum antibiotics. Depending on regional patterns of antibiotic resistance and unique patient variables, the particular antibiotic option may change. Antibiotics including Gentamicin, Ampicillin-sulbactam, Cefoxitin, and Ceftriaxone are frequently used. When the patient’s condition improves, the antibiotics may be shifted from intravenously administered to oral medications.

• Intravenous fluids: Hydration is essential, particularly if a fever or decreased oral intake is present.

• Pain relief: Nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen can be used to treat pain and discomfort.

• Management of fever: Antipyretic drugs might be used to reduce fever if it is uncomfortable or if it interferes with nursing.

• Surgical intervention: Occasionally, surgical drainage of uterine abscesses or other localized pus collections is required. Usually, uterine aspiration or curettage is used to do this.

Hospitalization may be indicated in severe cases of postpartum endometritis. This makes it possible to keep a careful eye on the mother’s health and guarantees that intravenous antibiotics and supportive care are given in the right way. If the patient has other difficulties or risk factors, hospitalization can also be necessary.

PREVENTION OF POSTPARTUM ENDOMETRITIS

• Antibiotic Prophylaxis: Giving antibiotics to pregnant women before they give birth can greatly lower their risk of developing postpartum endometritis, especially if they have certain risk factors including prolonged membrane rupture, protracted labor, or repeated vaginal checks. The particular antibiotic regimen will be determined by the woman’s unique situation and the managing clinician.

• Good Hygiene Practices: It is important to keep yourself clean while giving birth. During any invasive operations, such as vaginal exams or delivery, healthcare professionals should adhere to standard hand hygiene measures, use sterile gloves, and utilize clean tools.

• Cesarean Section (C-section) Considerations: Adherence to sterile methods is critical to reducing the risk of infection if a C-section is planned for or becomes necessary. In C-section instances, preventative antibiotics are typically given prior to surgical incision.

• Adequate Perineal Care: After delivery, it is crucial to keep the perineal area dry and clean. Women should be instructed to wash their perineum with warm water and a gentle soap (non- scented) before patting, not rubbing, the region dry. It is advisable to use fresh pads or sanitary napkins and to change them periodically to keep clean.

• Breastfeeding: Breastfeeding has been associated with a reduced risk of postpartum endometritis. The exact mechanism behind this protective effect is not fully understood, but it may be related to the hormonal changes and increased uterine contraction associated with breastfeeding immediately after delivery.

• Prophylactic Treatments: In certain cases, healthcare providers may recommend additional preventive measures. This may include the administration of additional antibiotics or antiseptic solutions before or after delivery, particularly for women with a high risk of infection.

• Encouraging early activity and ambulation after birth reduces the risk of postpartum endometritis. Getting up and moving around increases blood circulation, which promoteshealing and lowers the chance of infection.

CONCLUSION

Endometritis may seem a complicated health issue post-delivery, severity and occurrence may however be reduced if a woman immediately reports when she starts  to feel warm, particularly tender, or have a foul discharge even when she has been discharged home. Although discomfort or tenderness does not always indicate an oncoming infection, it is still better that a thorough examination be done to rule out Endometritis.