Post-partum endometritis is the infection of uterine lining following delivery or miscarriage; it is the most common cause of secondary PPH

Aetiology

• Certain conditions around labour increase the risk of endometritis, these include:
  • Prolonged rupture of membranes (PROM) / prolonged labour
  • Retained products (of pregnancy)
  • Caesarian section

Clinical features

Symptoms

• Abdominal pain
• Abnormal PV bleeding - PPH
• Offensive PV loss (lochia)
• Dyspareunia
• Dysuria
• General malaise

Signs

• Raised temperature
• Pain and uterine tenderness, which may radiate to the adnexae
• Tachycardia

Investigations

• Bloods: FBC, CRP, U+Es, coag., blood cultures
• High vaginal swab
• Pelvic ultrasound scan: can assist in the diagnosis of retained placental tissue
• Endometrial biopsy is diagnostic, although rarely appropriate