What Is Postpartum Endometritis?

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When you’re nearing your due date, you have a lot of things competing for your attention: packing your suitcase for the hospital or birthing center, setting up the crib, procuring diapers and other baby gear, finding a pediatrician, and learning about how to care for your new baby

The last thing you expect is to get sick yourself. You may not even be aware of potential infections that can develop during and after childbirth. Postpartum endometritis is one of those potential conditions that could occur, and involves an infection of the lining of the uterus, or endometrium. It develops after you deliver your baby. Most infections are mild and can be cleared up with a round of antibiotics, but sometimes a more serious infection can develop, which requires more extensive treatment. If left untreated, postpartum endometritis could lead to sepsis, shock, and possibly even organ failure. 

“Early treatment is key,” says Salena Zanotti, MD, an OB/GYN with the Cleveland Clinic. “It’s important to call and get examined if there are concerns about endometritis.” Ahead, learn more about postpartum endometritis, what the signs are, and when to call a healthcare professional.

Symptoms of Postpartum Endometritis

Fever and uterine tenderness are the most common symptoms of postpartum endometritis, along with a foul-smelling discharge. “If you try to touch the lower abdomen where the uterus is, you’re going to jump,” says Dr. Zanotti. “It’s very tender.”

Your doctor may keep an especially close eye out for signs of postpartum endometritis if you undergo a cesarean section, as it’s much more common in C-sections than in vaginal births. The risk is highest for people who try to deliver vaginally but end up getting a C-section, followed by those who have scheduled C-section deliveries, notes Matthew Macer, MD, the medical director at Halo Fertility. 

According to a Cochrane review of research, postpartum endometritis affects 1 to 3% of vaginal births and up to 27% of C-sections. Typically, postpartum endometritis sets in between two and 10 days after you deliver your baby, but it can develop up to six weeks after delivery.

How is Postpartum Endometritis Diagnosed?

If you develop a fever or uterine pain, your healthcare provider may want to start out with a pelvic examination to determine the possible source of your symptoms. They will likely also ask about any type of cervical discharge, and order bloodwork to provide additional information about any potential infection. In some cases, your provider may also take a culture of the cervix to check for chlamydia and gonorrhea. They may also conduct an endometrial biopsy.

Causes of Postpartum Endometritis

The culprit for this type of infection is bacteria—usually a mixture of different kinds. Often, it’s the result of the bacteria creeping into the uterus from the lower genital tract.

However, anytime you get surgery, that introduces the possibility of infection, too. After all, a C-section is a surgery that requires an incision, and bacteria could get into the wound, explains Dr. Zanotti.

Antibiotics are sometimes given to pregnant people undergoing a C-section to prevent infections from occurring in the first place. “In the U.S., we routinely give antibiotics within 60 minutes of a cesarean to significantly reduce the chance of this occurring,” says Dr. Macer. 

Treatment for Postpartum Endometritis

If your doctor determines you have postpartum endometritis, especially a moderate to severe case, you’ll receive a course of antibiotics administered through an IV. Your doctor may use a combination of clindamycin and gentamicin, as research suggests that’s an effective combination, but there are other antibiotic regimens that are sometimes used, too.

You should start to see improvement within 48 to 72 hours. If the IV antibiotics work and nothing else seems to be wrong, you probably won’t need a follow-up course of oral antibiotics.

A very small percentage of people with this infection may develop a complication such as sepsis, a hematoma, or necrotizing fasciitis. Additional surgery may become necessary.

How to Cope if You're Diagnosed With Postpartum Endometritis

Once you receive a diagnosis of postpartum endometritis, your provider will want to start you on antibiotics right away to knock out the infection and prevent complications. If you have a mild case and you’ve already gone home from the hospital, you may be able to take oral antibiotics, especially if you had a vaginal delivery. 

If you have to get IV antibiotics in the hospital, you may worry about what will happen to your baby. Talk to your doctor about making arrangements to breastfeed your newborn, suggests Dr. Zanotti. “We are very supportive,” she says. “We want to keep mom with the baby, but we want mom to be healthy, too.” 

After you undergo treatment, you may also be wondering what might happen down the road. “If diagnosed and treated appropriately, the risk on a woman’s fertility is minimal,” says Dr. Macer. “However, if not diagnosed or treated appropriately, the chronic pelvic infection can lead to scarring of the uterus or fallopian tubes and other important reproductive organs, which can lead to infertility.”

A Word From Verywell

If you notice that you’re feeling feverish or especially tender after giving birth, or experiencing a smelly discharge, let your nurse or doctor know right away. Pain or tenderness doesn’t necessarily signal an impending infection, but it’s better to let the experts know so they can examine you more closely, just in case. If you’ve already gone home when your symptoms start, be sure to call your provider. Let them help you determine the best step to take next.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American College of Obstetricians and Gynecologists (ACOG). 3 Conditions to Watch for After Childbirth.

  2. University of Florida Health. Endometritis.

  3. Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritisCochrane Database Syst Rev. 2015;2015(2):CD001067. doi:10.1002/14651858.CD001067.pub3

  4. The Johns Hopkins University and Health System. Surgical Site Infections.

  5. Taylor M, Pillarisetty LS. Endometritis. StatPearls. 2022.

By Jennifer Larson
Jennifer Larson is a seasoned journalist who regularly writes about hard-hitting issues like Covid-19 and the nation's ongoing mental health crisis, as well as healthy lifestyle issues like nutrition and exercise. She has more than 20 years' of professional experience and hopes to log many more.