Snapshot A 20-year-old, G1P1, recently gave birth to a healthy boy at 39 weeks gestation. He was delivered via cesarean section and the patient is now recovering on the unit. Approximately 2 days after the cesarean section the nurse reports the patient is febrile at 101°F (38°C). On physical examination, the surgical site is clean, there is mid-abdominal and uterine tenderness with foul-smelling lochia. Complete blood count reveals a leucocytosis of 18,000 cells/mm^3. Introduction Clinical definition infection of the decidua (pregnancy endometrium) fever 2-3 days postpartum is concerning for endometritis Epidemiology incidence 1-5% post-vaginal delivery 24-27% post-cesarean section risk factors maternal immunosuppression diabetes anemia obesity intrapartum and postpartum cesarean section can occur post-vaginal delivery; however, this is relatively less common prolonged labor and rupture of membranes multiple pelvic exams during labor chorioamnionitis vaginal infection Pathogenesis during labor and delivery normal vaginal flora colonizes uterine cavity Differential diagnosis infection of the abdominal incision toxic shock syndrome although rare normal postpartum period chills, edema, and lochia Prognosis most infections are mild and cured with antibiotic therapy prognostic variables favorable prophylactic antibiotics at the time of cesarean significantly reduces the incidence of postpartum infection Presentation Symptoms fever on postpartum day 2-3 Physical exam uterine tenderness midline abdominal pain Studies Diagnostic criteria this is a clinical diagnosis based on postpartum fever (≥ 100.4°F) that cannot be explained by any other etiology based on clinical history and physical exam additional findings that supports the diagnosis include leukocytosis foul-smelling (or purulent) lochia Differential Other causes of postpartum fever day 0 atelectasis day 1 urinary tract infection day 4-5 wound infection day 5-6 septic thrombophlebitis day 7-21 infectious mastitis Treatment Medical intravenous clindamycin wtih gentamicin indication a commonly used treatment regimen for managing postpartum endometritis Complications Sepsis Abscess