Secondary Post Partum Haemorrhage and Post-partum Endometritis

Post-partum endometritis is the infection of uterine lining following delivery or miscarriage; it is the most common cause of secondary PPH

Aetiology

  • Certain conditions around labour increase the risk of endometritis, these include:
    • Prolonged rupture of membranes (PROM) / prolonged labour
    • Retained products (of pregnancy)
    • Caesarian section

Clinical presentation

Symptoms

  • Abdominal pain
  • Abnormal PV bleeding - PPH
  • Offensive PV loss (lochia)
  • Dyspareunia
  • Dysuria
  • General malaise

Signs

  • Raised temperature
  • Pain and uterine tenderness, which may radiate to the adnexae
  • Tachycardia

Investigations

  • Bloods - FBC, CRP, U+Es, coag., blood cultures
  • High vaginal swab
  • Pelvic US scan can assist in the diagnosis of retained placental tissue
  • Endometrial biopsy is diagnostic, although rarely appropriate

Management

  • IV fluids
  • Pharmacological:
    • Antibiotics - co-amoxiclav (co-trimoxazole + metronidazole if penicillin allergic)
    • Uterotinics e.g. syntocinon (oxytocin), syntometrine, carboprost and misoprostol
  • Surgical:
    • Surgical measures such as insertion of a balloon catheter should be undertaken if there is excessive or continuing bleeding
    • D+C may be required if there are any retained products