KEY FACTS
Terminology
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Polymicrobial infection resulting from ascending spread of organisms from cervix or from incision into uterus
Imaging
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Endometritis is predominantly a clinical diagnosis: Postpartum fever and pelvic pain
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Imaging usually ordered to look for complications: Pyometrium, abscess, retained products of conception
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Endometrium may appear normal or be thick and heterogeneous
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Endometrial gas, fluid and inflammatory debris; gas bubbles alone are not diagnostic as gas is normal finding for up to 3 weeks postpartum, present in up to 21% of healthy patients
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Hyperechoic foci within endometrial cavity ± shadowing
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Large amount of echogenic fluid suspicious for pyometra
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May see increased flow on color Doppler
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Lack of ↑ flow does not rule out endometritis
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Fluid in cul-de-sac
Top Differential Diagnoses
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Retained products of conception
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Intrauterine blood/clot
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Asymptomatic postpartum endometrial gas
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Endometrial calcifications
Clinical Issues
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Most common cause of postpartum fever, 1-3% of vaginal deliveries, more common following cesarean section
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Occasionally associated with pelvic inflammatory disease or intrauterine device in nonobstetric patient
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Rarely leads to development of pelvic septic thrombophlebitis
Diagnostic Checklist
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Endometritis is predominantly clinical diagnosis
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In appropriate clinical setting (postpartum fever and pain), presence of endometrial fluid and bubbles is highly suggestive of endometritis
Scanning Tips
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Evaluate for color flow in endometrial debris, noting that gas bubbles may produce artifactual signal; confirm with spectral Doppler