INTRODUCTION – INFECTIONS AND AGENTS
Infections prevalent in the postpartum and postabortion period include urinary tract and genital tract infections (including endometritis, septic pelvic thrombophlebitis, pelvic inflammatory disease, and tubo-ovarian abscess), as well as mastitis, pneumonia (as a complication of anesthesia), and wound infection. Approximately 6% of women develop infections after vaginal delivery or cesarean section, the majority (94%) after hospital discharge. The most common postpartum infections are mastitis and urinary tract infection. This chapter reviews genital tract infections, mastitis, and episiotomy site infections. See Chapters 32, 37, and 57 for discussions of pneumonia, urinary tract infections, and surgical wound infections.
Endometritis: Postpartum and Postabortion
Endometritis is infection of the uterus. This may include the lining of the uterus (endometrium), the muscular layer (myometrium), or the entire organ. Endometritis is a polymicrobial infection occurring either at the time of delivery or during operative procedures via exposure of the upper genital tract to vaginal flora. Pathogens include aerobic and anaerobic gram-positive cocci (group A beta-hemolytic Streptococcus, coagulase-positive Staphylococcus aureus, group B Streptococcus, Streptococcus pneumoniae, and Enterococcus faecalis) as well as aerobic and anaerobic gram-negative agents (Escherichia coli, Gardnerella vaginalis, and Bacteroides fragilis). Other pathogens include those associated with prior sexually transmitted infection such as Chlamydia trachomatis and Neisseria gonorrhoeae, and those associated with bacterial vaginosis such as Mycoplasma hominis and Ureaplasma urealyticum.