Antibiotic regimens for endometritis after delivery
RHL practical aspects by Chongsomchai C
The prevention of endometritis is important. Infection prevention practices, including avoiding unnecessary caesarean section, appropriate management of prolonged labour, fewer vaginal examinations during labour, use of good sterile techniques and meticulous operative procedures during delivery, and providing appropriate prophylactic antibiotics during caesarean section should be routinely practised.
FIRST CONTACT (PRIMARY CARE LEVEL)
The diagnosis of endometritis should be considered when a postpartum woman has febrile morbidity (oral temperature ≥38.0°C or on two occasions between day 1-10 after birth) abdominal pain or foul smelling lochia. Careful physical examination to detect the source of infection is crucial. Once endometritis is diagnosed, appropriate antibiotic treatment should be started. If clindamicin is not available, or not affordable, the WHO-recommended (1)regimen of ampicillin plus gentamicin plus metronidazole should be used. If fever is still present 72 hours after treatment, the patient should be carefully re-evaluated and the diagnosis revised. If complication(s) (such as pelvic abscess, peritonitis, septic shock, etc.) are suspected the patient should be referred to higher level of health care immediately.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Whenever possible, clindamycin plus gentamicin should be used. Otherwise, the WHO-recommended regimen (see above) or a similar regimen in accordance with the local pattern of microorganisms may be used.
Exploratory laparotomy should not be delayed when there is failure of medical treatment.
AT HOME OR IN THE COMMUNITY
Pregnant women should be educated to contact a physician or a health care provider immediately if during pregnancy ruptured membranes are detected or suspected. All new mothers should be educated about the symptoms of endometritis and other postpartum morbidity, as well as how to avoid them.
References
- Mathai M, Sanghvi H, Guidotti RJ. Managing complications in pregnancy and childbirth : a guide for midwives and doctors. Geneva, World Health Organization 2000; S-110 .
This document should be cited as: Chongsomchai C. Antibiotic regimens for endometritis after delivery: RHL practical aspects (last revised: 27 October 2004). The WHO Reproductive Health Library; Geneva: World Health Organization.