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Uterine Infection (Endometritis)

What is Uterine infection (endometritis)?

Endometritis is an inflammation of the inner lining of the uterus (the endometrium) that is most often caused by a bacterial infection. The condition can develop after childbirth, miscarriage, gynecologic surgery, or in the setting of other pelvic infections. When the uterine lining becomes infected, it can cause pain, fever, abnormal bleeding, and, if left untreated, can spread to other pelvic organs or become life‑threatening.

The term “uterine infection” is sometimes used more broadly to include any infection that involves the uterus, but in clinical practice it most frequently refers to acute or chronic endometritis.

Common Causes

Endometritis is usually polymicrobial. The most frequent culprits are bacteria that normally inhabit the vagina or lower genital tract, but certain conditions increase the risk of these organisms reaching the uterine cavity.

• Post‑partum infection: Bacterial entry after vaginal or cesarean delivery (most common cause).
• Miscarriage or induced abortion: Tissue loss and cervical trauma allow organisms to ascend.
• Gynecologic surgery: Hysterectomy, dilatation & curettage (D&C), myomectomy, or hysteroscopy.
• Intrauterine device (IUD) use: Especially shortly after insertion or removal.
• Pelvic inflammatory disease (PID): Spread from the cervix, uterus, fallopian tubes, or ovaries.
• Sexually transmitted infections (STIs): Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium.
• Diabetes or immunosuppression: Reduced ability to fight infection.
• Prolonged rupture of membranes: During labor >18‑24 hours increases bacterial ascent.
• Retention of placental fragments: Tissue acts as a nidus for bacterial growth.
• Obstetric instrumentation: Forceps, vacuum extraction, or any instrument that disrupts the cervical barrier.

Associated Symptoms

Symptoms can range from mild to severe and may appear within a few days after the precipitating event, but sometimes develop weeks later.

• Fever ≥ 38 °C (100.4 °F) or chills
• Lower abdominal or pelvic pain/cramping
• Foul‑smelling vaginal discharge (often purulent)
• Abnormal uterine bleeding or spotting
• Uterine tenderness on examination
• Increased heart rate (tachycardia)
• Fatigue, malaise, or feeling “flu‑like”
• Difficulty urinating or painful urination (if infection spreads)
• Loss of appetite or nausea

When to See a Doctor

Endometritis can progress quickly, especially after childbirth or surgical procedures. Seek medical care promptly if you experience any of the following:

• Fever lasting more than 24 hours postpartum or after a procedure.
• Severe, worsening pelvic pain or a feeling of pressure that does not improve with over‑the‑counter pain medication.
• Foul‑smelling, green‑yellow, or copious vaginal discharge.
• Heavy vaginal bleeding that soaks more than one pad per hour.
• Rapid heart rate (>100 bpm) or low blood pressure (feeling dizzy or faint).
• Persistent nausea, vomiting, or inability to keep fluids down.
• Any new symptoms after an IUD insertion or removal.

When in doubt, call your obstetrician‑gynecologist, primary‑care provider, or go to an urgent‑care clinic. Early treatment reduces the risk of complications such as sepsis, infertility, or chronic pelvic pain.

Diagnosis

Diagnosis is based on a combination of clinical assessment, laboratory testing, and sometimes imaging.

1. Medical History & Physical Exam

• Review of recent obstetric events, surgeries, IUD use, or STI exposure.
• Vital signs to look for fever, tachycardia, or hypotension.
• Abdominal and pelvic exam – tenderness, uterine size, and presence of discharge.

2. Laboratory Studies

• Complete blood count (CBC): Often shows leukocytosis (elevated white blood cells).
• C‑reactive protein (CRP) or erythrocyte sedimentation rate (ESR): Markers of inflammation.
• Vaginal and cervical cultures: Identify specific bacteria or STI pathogens.
• Urine analysis: To exclude urinary tract infection, which can coexist.

3. Imaging (when indicated)

• Transvaginal ultrasound: Checks for retained products of conception, abscess, or thickened endometrium.
• Pelvic CT or MRI: Reserved for complicated cases where an abscess or spread beyond the uterus is suspected.

4. Endometrial Sampling (rare)

In chronic or recurrent cases, a small biopsy of the endometrium may be taken to look for bacterial colonies, fungi, or atypical cells.

Treatment Options

Prompt antibiotic therapy is the cornerstone of treatment. The route (intravenous vs. oral) and duration depend on severity, pregnancy status, and patient‑specific factors.

1. Antibiotic Regimens

Condition	Typical IV Regimen (12‑24 hr)	Oral Switch (after 48‑72 hr)
Post‑partum or post‑surgical acute endometritis	Clindamycin 900 mg IV q8h + Gentamicin 5 mg/kg IV q24h	Clindamycin 300 mg PO q6h + Amoxicillin‑clavulanate 875/125 mg PO q12h
Community‑acquired anaerobic/Gram‑negative mix (e.g., after IUD removal)	Cefoxitin 2 g IV q6h + Doxycycline 100 mg PO q12h	Continue same agents orally if tolerated

Regimens are adapted for penicillin allergy, renal dysfunction, or pregnancy (e.g., ampicillin + gentamicin + clindamycin for pregnant patients). Treatment usually lasts 10‑14 days; severe cases may require a 4‑week course.

2. Supportive Care

• Fever control with acetaminophen or ibuprofen (if no contraindication).
• Intravenous fluids if dehydrated or febrile.
• Analgesics for pain relief.
• Monitoring of vital signs and urine output.

3. Surgical Intervention

• Drainage of an intra‑uterine or pelvic abscess: Typically via CT‑guided percutaneous drainage or laparoscopy.
• Removal of retained tissue: Hysteroscopic curettage for retained placenta fragments.
• IUD removal: If an IUD is present and suspected as the infection source.

4. Home‑Based Measures (once stable)

• Complete the full antibiotic course, even if symptoms improve.
• Rest and avoid heavy lifting for at least 2 weeks.
• Maintain good perineal hygiene—wash with warm water, change pads frequently.
• Stay well‑hydrated and eat a balanced diet rich in protein to aid healing.
• Use a heating pad on low setting for comfort, not for more than 20 minutes at a time.

Prevention Tips

Many cases of endometritis are preventable with proper care before, during, and after obstetric or gynecologic events.

• Hand hygiene and sterile technique: Essential for all vaginal examinations, deliveries, and surgeries.
• Prophylactic antibiotics: Single‑dose cefazolin or clindamycin‑gentamicin before Cesarean section or hysterectomy reduces infection risk (CDC guidelines).
• Prompt treatment of STIs: Regular screening for chlamydia, gonorrhea, and trichomoniasis.
• Careful IUD insertion: Use aseptic technique; schedule a follow‑up visit 4‑6 weeks later to confirm proper placement.
• Limit unnecessary vaginal exams or cervical manipulations: Especially during early pregnancy.
• Timely removal of retained placental tissue: Ultrasound follow‑up after delivery if heavy bleeding persists.
• Control chronic conditions: Keep diabetes, HIV, or other immunosuppressive disorders well managed.
• Educate patients: Explain warning signs of infection before discharge after childbirth or surgery.

Emergency Warning Signs

Key Take‑aways

Uterine infection (endometritis) is a potentially serious condition most often linked to childbirth, miscarriage, or gynecologic procedures. Early recognition of fever, pelvic pain, and abnormal discharge, followed by prompt medical evaluation, greatly reduces the risk of complications. Treatment typically involves a targeted course of antibiotics, supportive care, and, when needed, surgical drainage. Preventive measures—especially sterile technique, prophylactic antibiotics for high‑risk surgeries, and early STI treatment—play a pivotal role in lowering incidence.

For the most up‑to‑date recommendations, consult reputable sources such as the Mayo Clinic, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

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