Endometritis
Postpartum Endometritis Evidence Based Paper
March 13, 2012
Endometritis is the inflammation or irritation of the uterus, which is a common post partum complication that occurs in more than 15% of all pregnancies and is currently the leading cause of maternal mortality (Scott & Hasik, 2001). When endometritis is not related to pregnancy, it is referred to as pelvic inflammatory disease (PID). The Centers for Disease Control and Prevention (CDC) 2010 sexually transmitted diseases treatment guideline defines PID as any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
From a pathologic perspective, endometritis can be classified as acute versus chronic. Acute endometritis is distinguished by the presence of neutrophils within the endometrial glands. Chronic endometritis is characterized by the presence of plasma cells and lymphocytes within the endometrial stroma. Chronic endometritis in the postpartum or post abortion patient is usually associated with retained products of conception after delivery or abortion. In the nonobstetric population, chronic endometritis has been associated with infections such as chlamydia, tuberculosis, bacterial vaginosis, and the presence of intrauterine devices (Rivlin, 2011).
Early-onset postpartum endometritis occurs within two days of delivery, and the late-onset of the disease can occur up to six weeks postpartum. This condition will usually start as a local infection at the placental attachment site and if left untreated, can spread to the entire uterine endometrium (French & Smaill, 2004). There are numerous risks associated with this condition, and diagnosis relies heavily on the clinical judgment of the practitioner.
The contamination of the uterine cavity with vaginal organisms during labor and delivery causes the disease. Both bacterial and viral infections may initiate endometritis and many of the agents that cause the infection are naturally present in the vagina.
March 13, 2012
Endometritis is the inflammation or irritation of the uterus, which is a common post partum complication that occurs in more than 15% of all pregnancies and is currently the leading cause of maternal mortality (Scott & Hasik, 2001). When endometritis is not related to pregnancy, it is referred to as pelvic inflammatory disease (PID). The Centers for Disease Control and Prevention (CDC) 2010 sexually transmitted diseases treatment guideline defines PID as any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
From a pathologic perspective, endometritis can be classified as acute versus chronic. Acute endometritis is distinguished by the presence of neutrophils within the endometrial glands. Chronic endometritis is characterized by the presence of plasma cells and lymphocytes within the endometrial stroma. Chronic endometritis in the postpartum or post abortion patient is usually associated with retained products of conception after delivery or abortion. In the nonobstetric population, chronic endometritis has been associated with infections such as chlamydia, tuberculosis, bacterial vaginosis, and the presence of intrauterine devices (Rivlin, 2011).
Early-onset postpartum endometritis occurs within two days of delivery, and the late-onset of the disease can occur up to six weeks postpartum. This condition will usually start as a local infection at the placental attachment site and if left untreated, can spread to the entire uterine endometrium (French & Smaill, 2004). There are numerous risks associated with this condition, and diagnosis relies heavily on the clinical judgment of the practitioner.
The contamination of the uterine cavity with vaginal organisms during labor and delivery causes the disease. Both bacterial and viral infections may initiate endometritis and many of the agents that cause the infection are naturally present in the vagina.
References: Ackley, B. J., & Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care French, L. (2003). Prevention and treatment of postpartum endometritis. Current Women’s Health Reports, 3(4), 274-279 French, L., & Smaill, F. M. (2004). Antibiotic regimens for endometritis after delivery Moldenhauer, J. S. (2008, November). Puerperal endometritis. Retrieved from http://www.merckmanuals.com/professional/gynecology_and_obstetrics/postpartum_care_and_associated_disorders/puerperal_endometritis.html Nelson, C. B. (2010, January 22). Routine antibiotic use reduces mothers’ infection risk from c- section Olsen, M. A., Butler, A. M., Willers, D. M., & Gilad, A. G. (2010). Risk factors for endometritis after low transverse cesarean delivery Pillitteri, A. (1999) Maternal & Child Health Nursing, (3rd ed. pp.789-792). Philadelphia: PA: Lippincott. Rivlin, M. E. (2011, June 14) Endometritis. Retrieved from http://emedicine.medscape.com/article/254169-overview Scott, L. D., & Hasik, K. J. (2001). The similarities and differences of endometritis and pelvic inflammatory disease