ENDOMETRITIS

Question 1

Approach to the Critically Ill Endometritis

Answer 1

intravenous fluids at 30 mL/kg intravenous fluids and reassess volume status.

Vasopressors:
Norepinephrine continuous infusion at a rate of 0.01-0.3 μg/kg/minute; titrate by 0.02 μg/kg/minute every 5 minutes

Vasopressin continuous infusion of 0.01-0.04 units/minute

Gold Standard Antibiotics:

Gentamicin 5 mg/kg intravenous every 24 hours or 1.5 mg/kg intravenous every 8 hours and
AND
Clindamycin 900 mg intravenous every 8 hours

OR

Piperacillin-tazobactam 3.375 g intravenous every 6 hours

OR

Meropenem 1-2 g intravenous as a loading dose, followed by 0.5-1 g intravenous every 8 hour
Consult obstetrics

Question 2

History & Physical

Answer 2

Post Partum (MC Cesarean Section)

Fever (MC presenting symptom)

Abdominal Pain

Foul Smelling Lochia

Diagnosis is clinical

Question 3

Critical DDx

Answer 3

Endometritis

Toxic Shock Syndrome

Necrotizing Fascitis

Tubo-Ovarian Abscess

Pelvic Inflammatory Disease

Appendicitis

Pyelonephritis / Infected Nephrolithiasis

Intraabdominal Abscess

Question 4

Investigations

Answer 4

Cervical and Vaginal Cultures are usually contaminated

Ultrasound is non specific

Question 5

Management

Answer 5

Gold Standard Antibiotics:

Gentamicin 5 mg/kg intravenous every 24 hours or 1.5 mg/kg intravenous every 8 hours and
AND
Clindamycin 900 mg intravenous every 8 hours

OR

Piperacillin-tazobactam 3.375 g intravenous every 6 hours

OR

Meropenem 1-2 g intravenous as a loading dose, followed by 0.5-1 g intravenous every 8 hour

Consult Obstetrics

Question 6

Management: Stable

Answer 6

Consultation with OBGYN

Doxycycline 100 mg by mouth every 12 hours AND
metronidazole 500 mg by mouth every 12 hours

OR

Amoxicillin-clavulanate 875 mg/125 mg by mouth every 12 hours

Question 7

Managment: Unstable

Answer 7

Consult Obstetrics

Gold Standard Antibiotics:

Gentamicin 5 mg/kg intravenous every 24 hours or 1.5 mg/kg intravenous every 8 hours and
AND
Clindamycin 900 mg intravenous every 8 hours

OR

Piperacillin-tazobactam 3.375 g intravenous every 6 hours

OR

Meropenem 1-2 g intravenous as a loading dose, followed by 0.5-1 g intravenous every 8 hour

Question 8

Disposition: Unstable

Answer 8

All patients requiring intravenous antibiotics and those with endometritis following a cesarean delivery should be admitted to the hospital.

Operating room/surgery
Patients who have developed an abscess, toxic shock syndrome, or necrotizing fasciitis will require surgery.