Postpartum endometritis: infection of the womb lining after birth

Endometritis means infection of the endometrium, the lining of the womb. After a birth, the womb has a wound where the placenta was attached, and the NHS notes you may also have tears or cuts nearby, which is why internal products such as tampons are avoided until after the postnatal check. Somerset NHS Foundation Trust explains that after having a baby you can get an infection in perineal stitches, a caesarean wound, inside the womb, in the breasts or in the urine, and that these are not common but may need medicine.

The RCOG notes in its early miscarriage information that an infection of the womb lining can also follow a miscarriage, occurring in two to three out of 100 women and treated with antibiotics. It is therefore not limited to birth, and the signs are similar.

Somerset describes a womb infection as bleeding more than usual, seeing blood clots, blood that smells bad, and a belly that hurts a lot or feels very warm, with general infection signs of fever, feeling very cold or shaky, and feeling very tired or achy like flu. The NHS early days page says to speak to your GP, midwife or health visitor if postnatal bleeding comes with a temperature over 38C, an unusual smell, tummy pain that gets worse, heavier or unchanging bleeding, clots, or worsening perineal pain, and that it could be a sign of infection.

NICE says all women should be told at the first postnatal contact to seek advice without delay if there is sudden or very heavy bleeding or persistent or increased bleeding (which could indicate retained placental tissue or endometritis), abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell (which could indicate infection).

The NHS lists infection of the womb lining as a common risk of caesarean section, with symptoms including a fever, tummy pain, abnormal vaginal discharge and heavy vaginal bleeding. NICE guidance on caesarean birth says endometritis, urinary tract and wound infections occur in about 8% of women who have a caesarean birth, and that giving prophylactic antibiotics before skin incision reduces the risk of maternal infection more than giving them afterwards, with no known effect on the baby. It also recommends vaginal cleansing with an antiseptic before caesarean birth in women whose waters have broken to reduce the risk of endometritis.

Early membrane rupture can also increase the risk of infection reaching the womb. The RCOG leaflet on waters breaking early describes chorioamnionitis, infection in the womb after the membranes have broken, which is monitored for with temperature, pulse and blood tests. NICE intrapartum guidance recommends a single dose of intravenous antibiotic after a forceps or ventouse birth.

The NHS describes sepsis as a serious reaction to an infection that can be life-threatening, develops quickly and needs urgent hospital treatment. Symptoms in adults include confusion or slurred speech, uncontrollable shivering, muscle pain, difficulty breathing, blue, pale or blotchy skin, a very high or low temperature and passing very little urine. The NHS says to call 999 or go to A&E if you are breathing very fast, are confused, have blue or blotchy skin, a very high or very low temperature, or have symptoms you are worried might be sepsis, and not to drive yourself.

NICE guideline NG255 on suspected sepsis in pregnant or recently pregnant people treats signs such as new altered mental state, a raised breathing rate, low blood pressure, a high heart rate, not passing urine in 18 hours and redness, swelling or discharge at a surgical site as higher-risk features, which prompt immediate senior assessment. NICE postnatal guidance refers clinicians to it for any woman with symptoms or signs of sepsis and says to assess the baby for infection if puerperal sepsis is confirmed or suspected.

The RCOG says that when bleeding is heavy or continues you may need to go to hospital for further tests, that you may be given antibiotics, through a drip if needed, and that occasionally an operation is required to remove remaining placental tissue. Your baby can usually stay with you and you can continue to breastfeed. Treatment is chosen by your clinician after examination; never start or stop an antibiotic without advice, and finish any course you are given. NICE advises that if you seek advice about bleeding after birth the severity is assessed with attention to anaemia and low weight as factors that worsen the consequences.

The patient-information pages used here do not give a standard antibiotic regimen or hospital stay length, because these depend on the local guideline and how unwell you are. Ask your team what to expect.

The NHS advises not using tampons or menstrual cups until after the 6-week postnatal check, changing pads regularly and washing hands before and after. NICE advises daily showering of the perineum, frequent pad changes and hand-washing, and offering an examination if you or your professional have concerns about healing. The postnatal midwife checks for infection, pain, discharge and bleeding at each contact, so describe any change. Postnatal schedules differ between UK nations.