Polymicrobial infection resulting from ascending spread of organisms from cervix or from incision into uterus

Endometritis is predominantly a clinical diagnosis: Postpartum fever and pelvic pain

Imaging usually ordered to look for complications: Pyometrium, abscess, retained products of conception

Endometrium may appear normal or be thick and heterogeneous

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

Hyperechoic foci within endometrial cavity ± shadowing

Large amount of echogenic fluid suspicious for pyometra

May see increased flow on color Doppler

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  Lack of ↑ flow does not rule out endometritis

Fluid in cul-de-sac

Retained products of conception

Intrauterine blood/clot

Asymptomatic postpartum endometrial gas

Endometrial calcifications

Most common cause of postpartum fever, 1-3% of vaginal deliveries, more common following cesarean section

Occasionally associated with pelvic inflammatory disease or intrauterine device in nonobstetric patient

Rarely leads to development of pelvic septic thrombophlebitis

Endometritis is predominantly clinical diagnosis

In appropriate clinical setting (postpartum fever and pain), presence of endometrial fluid and bubbles is highly suggestive of endometritis

Evaluate for color flow in endometrial debris, noting that gas bubbles may produce artifactual signal; confirm with spectral Doppler