Metritis/Endometritis

Medically Sound Treatments

Abstract

If antimicrobials are to be used effectively for the treatment of metritis/endometritis, it is important to understand the bacteriology of the postpartum uterus. A wide variety of bacterial species have been isolated from the postpartum uterus. These isolates include grampositive and negative bacteria that have aerobic to fastidious anaerobic requirements. Isolation of fastidious obligate anaerobes from the postpartum uterus provides supporting evidence that the postpartum uterus is an anaerobic environment. Presence of fastidious anaerobic bacteria implies that antimicrobials should be selected that are active in an anaerobic environment. The bacterial species, frequency of isolation, and relative concentration of bacteria species change with time through the postpartum period. Most species of bacteria isolated from the uterus have little significance with the exception of clostridium, Actinomyces pyogenes, and gram-negative anaerobes. A pyogenes and gram-negative anaerobes are components of metritis in the early postpartum period as well as the primary cause of severe endometritis in the middle and late postparturm period. Clostridial organisms are frequently a component of severe postpartum metritis. Hartigan, et al., 1974, observed that intrauterine infections with A pyogenes invariably induced endometritis. Severity of the endometrial inflammation was determined by the duration of the infection and whenever the infection persisted for more than a week, severe endometritis developed. Gram-negative anaerobes like Fusobacterium necrophrum and Bacteroides spp act synergistically with A pyogenes, resulting in a more severe endometrial pathology than with A pyogenes alone.