status.3 Anemia is a risk factor and is thought to be related to poor nutrition or low socioeconomic status.3 Advanced age and body mass index (BMI) are both associated with increased prevalence of postpartum infections.4 Other risk factors include diabetes and labor prior to cesarean section.3 The risk of infection is higher in lower resource settings where other infections such as malaria, typhoid, and tetanus are also prevalent.
toxic shock syndrome must also be considered. Several cases of postpartum endometritis caused by C. sordellii are reported, with an almost 70% mortality rate.12,13 Reported signs and symptoms include sudden onset of influenza-like symptoms in previously healthy women, progressive refractory hypotension, local and spreading tissue edema, and absence of fever but with laboratory findings including marked leukocytosis and elevated hematocrit, usually from toxic shock.12
TABLE 30.1 Risk Factors for Endometritis
Infected pelvic mass such as abscess, infected hematoma, SPT, or infected retained placenta
Resistant organisms such as enterococcus that are resistant to cephalosporin-like antibiotics, clindamycin, and gentamicin
Pyelonephritis, pneumonia, or intravenous catheter phlebitis
Inadequate antibiotic dosing