Postpartum Endometritis Clinical Practice Guidelines (2019)

Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Société de Pathologie Infectieuse de Langue Française (SPILF)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 30, 2019

Clinical guidelines on postpartum endometritis were released in March 2019 by the Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Société de Pathologie Infectieuse de Langue Française (SPILF).[1]

Caesarean delivery is the most significant risk factor for postpartum endometritis, particularly if performed after labor has begun.

Presentation and Diagnosis

Symptoms of postpartum endometritis include abdominopelvic pain, hyperthermia, and abnormal lochia. Uterine mobilization pain confirms the diagnosis.

Treatment

Preferred antibiotic: The first-line antibiotic is amoxicillin-clavulanic acid 3-6 g/d (depending on weight) IV or PO.

Penicillin allergy: In patients with penicillin allergy, a combination of clindamycin 600 mg 4 times/day plus gentamicin 5 mg/kg once a day may be used (caution in breastfeeding women).

Duration: Treatment is administered until 48 hours of apyrexia and resolved pelvic pain. If fever or pelvic pain persists for more than 72 hours of antibiotic therapy, perform pelvic imaging to evaluate for placental retention, septic thrombophlebitis, deep abscess, or other surgical complications.

Septic thrombophlebitis, if present, should be treated with heparin therapy for 6 weeks or more if embolism or thrombotic risk factors are also present.

Prevention

If possible, swab the vagina with iodinated polyvidone or chlorhexidine before caesarean delivery. In addition, extraction of the placenta must be spontaneous.

For more information, please go to Endometritis.

For more Clinical Practice Guidelines, please go to Guidelines.

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