Womb Infection (Endometritis) – A Complete Patient Guide

Overview

Endometritis is an inflammation and infection of the inner lining of the uterus (the endometrium). It most often occurs after childbirth, miscarriage, or gynecologic surgery, but it can also develop after procedures such as hysteroscopy or dilation & curettage (D&C). The condition is usually caused by bacteria that ascend from the vagina or are introduced during surgery.

• Who it affects: Primarily women of child‑bearing age, especially those who have recently given birth (post‑partum endometritis). It can also affect post‑menopausal women after uterine procedures.
• Prevalence: In the United States, post‑partum endometritis occurs in about 1–3 % of vaginal deliveries and up to 10 % of Cesarean sections (C‑section) 【1】. Worldwide rates vary, with higher incidence in low‑resource settings where sterile technique may be limited.

Symptoms

Symptoms can appear anywhere from a few days to a week after the inciting event. Not every woman experiences all of them.

Causes and Risk Factors

Common Causes

• Ascending bacterial infection – Vaginal flora (e.g., Streptococcus, Staphylococcus aureus, Escherichia coli, anaerobes) travel up the genital tract.
• Post‑operative contamination – During C‑section, D&C, hysteroscopy, or endometrial ablation.
• Retained products of conception – Placental tissue left after delivery or miscarriage provides a nidus for bacteria.
• Sexually transmitted infections (STIs) – Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes can contribute.

Key Risk Factors

• Cesarean delivery (especially without prophylactic antibiotics)
• Prolonged labor or membrane rupture (>18 hours)
• Multiple vaginal examinations during labor
• Obesity (BMI ≥ 30 kg/m²)
• Diabetes mellitus or other immunocompromising conditions
• Previous uterine surgery or scarring
• Smoking
• Uncontrolled bacterial vaginosis or bacterial overgrowth

Diagnosis

Timely diagnosis relies on a combination of clinical assessment and targeted testing.

Clinical Evaluation

• Detailed history (timing of delivery/procedure, symptoms, sexual history).
• Physical exam: fever, uterine tenderness, foul‑smelling discharge.

Laboratory Tests

• Complete blood count (CBC): Elevated white blood cell count (leukocytosis) supports infection.
• Blood cultures: Recommended if fever >38.5 °C or signs of sepsis.
• Vaginal/cervical swab: Aerobic and anaerobic cultures; nucleic acid amplification tests (NAAT) for STIs.

Imaging

• Trans‑abdominal or trans‑vaginal ultrasound: Checks for retained tissue, abscess, or fluid collections.
• CT or MRI: Reserved for complicated cases (e.g., suspected pelvic abscess).

Diagnostic Criteria (per CDC)

A diagnosis is made when a woman has a fever ≥38 °C plus at least one of the following: uterine tenderness, foul‑smelling lochia, or purulent cervical discharge, after ruling out other sources of infection 【2】.

Treatment Options

Antibiotic Therapy

Empiric broad‑spectrum antibiotics are started immediately, then tailored based on culture results.

• First‑line (inpatient): Clindamycin 900 mg IV every 8 h + Gentamicin 5 mg/kg IV loading dose, then 1.5 mg/kg q12h.
• Alternate outpatient regimen (if stable): Amoxicillin‑clavulanate 875/125 mg PO twice daily for 10–14 days.
• For penicillin‑allergic patients: Clindamycin + Aztreonam or a fluoroquinolone.

Duration is typically 10‑14 days, but longer courses are used if retained tissue or an abscess is present.

Surgical/Procedural Management

• Dilation & Curettage (D&C): Removes retained placental fragments; often needed when antibiotics alone are insufficient.
• Percutaneous drainage: Image‑guided drainage of a pelvic abscess.
• Laparoscopic or open surgery: Rare; reserved for severe, refractory infection.

Supportive Care

• IV fluids to maintain hydration and blood pressure.
• Analgesics (acetaminophen or NSAIDs) for pain and fever.
• Monitoring vitals every 4–6 hours for the first 24‑48 hours.

Lifestyle & Home Measures (post‑discharge)

• Complete the full antibiotic course, even if symptoms improve.
• Rest and avoid heavy lifting for at least 2 weeks.
• Maintain good perineal hygiene—change pads frequently, wipe front‑to‑back.
• Stay well‑hydrated and eat a balanced diet rich in protein and vitamins.

Living with Womb Infection (Endometritis)

Even after successful treatment, many women wonder how to manage day‑to‑day life while the uterus heals.

Daily Management Tips

1. Track symptoms: Keep a log of temperature, pain level, and any discharge.
2. Follow‑up appointments: Usually within 1‑2 weeks after completing antibiotics; ensure the uterus has returned to normal size on ultrasound.
3. Pain control: Use scheduled acetaminophen; reserve ibuprofen for breakthrough pain if no contraindications.
4. Pelvic floor exercises: Gentle Kegels can improve circulation and reduce post‑partum discomfort once pain subsides.
5. Contraception: Discuss with your provider; barrier methods reduce STI risk, while hormonal methods may affect uterine bleeding patterns.
6. Breastfeeding: Most antibiotics used (clindamycin, ampicillin‑sulbactam) are safe; confirm with your pediatrician.
7. Emotional health: Post‑partum infections can be stressful. Seek support from partners, counselors, or postpartum support groups.

Prevention

Many cases are preventable with proper obstetric and gynecologic care.

• Prophylactic antibiotics: Administered before C‑section or hysteroscopic procedures dramatically cuts risk (by ~70 %).
• Limit vaginal examinations: Only perform when clinically necessary during labor.
• Prompt treatment of bacterial vaginosis or STIs: Reduces bacterial load that could ascend.
• Good hand hygiene and sterile technique: Critical for all invasive uterine procedures.
• Controlled labor: Early induction when membranes are ruptured for >18 hours lowers infection risk.
• Smoking cessation and weight management: Improves immune response.

Complications

If left untreated, endometritis can lead to serious, sometimes life‑threatening problems.

• Sepsis and septic shock – systemic infection with organ dysfunction.
• Pelvic abscess – collection of pus that may require drainage.
• Infertility – scarring of the endometrium ( Asherman’s syndrome ) can impede implantation.
• Chronic pelvic pain – persistent pain after infection resolves.
• Adhesions – fibrous bands that can cause bowel obstruction or future surgical difficulties.
• Prolonged postpartum hemorrhage – inflamed tissue may not contract properly.

According to a 2020 systematic review, about 5 % of severe endometritis cases progress to sepsis, with a mortality rate of 2‑3 % when not promptly treated 【3】.

When to Seek Emergency Care

References

1. American College of Obstetricians and Gynecologists. Postpartum Hemorrhage and Endometritis. 2022.
2. Centers for Disease Control and Prevention. Guideline for the Prevention of Surgical Site Infection, 2017.
3. Mahajan, S. et al. “Severe post‑partum endometritis: A systematic review of outcomes.” Obstetrics & Gynecology, 2020;136(1):55‑63.
4. Mayo Clinic. Endometritis – Symptoms and Causes. Accessed March 2024.
5. World Health Organization. Maternal infections. 2023.