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PubMed1988

Microbial aetiology and diagnostic criteria of postpartum endometritis in Nairobi, Kenya.

Using a protected triple lumen device, Neisseria gonorrhoeae or Chlamydia trachomatis, or both, were isolated from the endometriums of five out of 35 women with clinical postpartum endometritis compared with none of a control group of 30 puerperal women without endometritis (p less than 0.05) in Nairobi, Kenya. These sexually transmitted agents were also found in 12 cervical specimens from women with and three without postpartum endometritis (p = 0.04). Mycoplasma hominis and Ureaplasma urealyticum were equally isolated from the endometrium in both groups. Histology showed plasma cell infiltration in 6/25 patients compared with 1/22 controls (p = 0.06). A history of foul lochia (p less than 0.01) and abdominal pain (p = 0.02) were associated with postpartum endometritis. Sexually transmitted agents appear to be major causes of puerperal upper genital tract infections in Nairobi.

Adult↗

PubMed1976

Untreated endocervical gonorrhea and endometritis following elective abortion.

A matched-pair analysis of 228 cases of endometritis occurring over a two-year period in 4,823 elective abortion patients was carried out. Patients with postabortal endometritis were matched with control subjects for age, parity, race, pay status, time of abortion, and type of abortion procedure. The prevalence of endocervical gonorrhea was 2.7% in the entire group seeking abortion, with 14.7% of patients with gonorrhea subsequently developing endometritis. The matched-pair analysis detected a threefold increased risk for endometritis in patients with untreated gonoccocal endocervicitis when compared with control subjects (p less than 0.05). The significance of these findings to centers performing abortions is discussed.

Abortion, Induced↗

PubMed1983

The relationship of maternal antibody levels to post-cesarean section endometritis.

One hundred eight pneumococcal polysaccharide antibody levels were determined by radioimmunoassay preoperatively in 18 patients who underwent elective repeat cesarean section. Eight patients developed post-cesarean section endometritis, and 10 did not. The endometritis group did not vary significantly from the noninfected group in preoperative hematocrit, social status, number of previous pregnancies, maternal and newborn weights, length of operation, and Apgar scores. Mean antibody levels in the endometritis group were significantly lower than those in the control group (49 versus 103 ng/ml; p less than 0.05). Mean antibody levels for the six serotypes in the endometritis group were significantly lower than those in the control group (p less than 0.05). This study indicated that a healthy maternal immune system may play an important role in preventing post-cesarean section morbidity. Pneumococcal polysaccharide antibody levels may be used in pregnancy to assess the risk for post-cesarean section infections.

Adult↗

PubMed1993

Antibiotic prophylaxis against postpartum endometritis after vaginal delivery: a prospective randomized comparison between Amox-CA (Augmentin) and abstention.

The most common adverse outcome associated with vaginal delivery is endometritis. It plays a significant role in postpartum morbidity and mortality. There is considerable evidence to support the idea that a single dose of antibiotic after vaginal delivery might decrease the incidence of postpartum endometritis. In this study the evaluation of the efficacy of antibiotic prophylaxis was based upon comparison of a group of patients given a single dose of Amox-CA (Augmentin) with a group of patients without treatment. The study was performed in the Department of Obstetrics and Gynecology of the A. Béclère Public Hospital, Clamart, France (Paris-Sud University). The patients who were the subject of the study had delivered vaginally during the period of 1 year, and were free of any clinical diagnosis of chorioamnionitis or other extragenital infection, had a maternal temperature of less than 38 degrees C during labor and 1 h after delivery, and had no history of allergy to penicillins or cephalosporins. After application of exclusion criteria, 1373 patients were randomized and 1291 included 610 in Group I given Amox-CA and 681 in Group II without any antibiotic. A single dose of 1.2 g of Amox-CA was given by intravenous injection, 1 h after delivery, in Group I. Patients of Group II received no injection. Postpartum status was evaluated before the patient left hospital and 2 weeks later. The two groups were similar in terms of demographic and clinical parameters. Four patients developed endometritis in Group I (4/610, 0.66%). Sixteen patients in Group II developed endometritis (16/680, 2.38%) (P = 0.013; 95% confidence interval (CI), 0.36-3.08%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Plasma cell endometritis in women with symptomatic bacterial vaginosis.

OBJECTIVE: To evaluate the endometrial microbiology and histopathology in women with symptomatic bacterial vaginosis but no signs or symptoms of upper genital tract disease or other vaginal or cervical infections. METHODS: Endometrial biopsies were performed on 41 women complaining of vaginal discharge or pelvic pain at a sexually transmitted disease clinic. These women had neither culture nor serologic evidence of Neisseria gonorrhoeae or Chlamydia trachomatis infection. Twenty-two women with bacterial vaginosis diagnosed by Gram stain examination of vaginal fluid, but with neither signs nor symptoms of upper genital tract infection, were compared with 19 women who had no evidence of bacterial vaginosis on vaginal fluid Gram stain. Endometrial biopsies were evaluated for histopathologic evidence of plasma cell endometritis and were cultured for N gonorrhoeae, C trachomatis, aerobic and anaerobic bacteria, Mycoplasma species, and Ureaplasma urealyticum. RESULTS: Ten of 22 women with bacterial vaginosis had plasma cell endometritis, compared with one of 19 controls (odds ratio [OR] 15, 95% confidence interval [CI] 2-686; P < .01). Bacterial vaginosis-associated organisms were cultured from the endometria of nine of 11 women with and eight of 30 women without plasma cell endometritis (OR 12.4, 95% CI 2-132; P = .002). CONCLUSION: Plasma cell endometritis was frequently present in women with bacterial vaginosis and without other vaginal or cervical infections. This suggests the possibility of an association between bacterial vaginosis and nonchlamydial, nongonococcal, upper genital tract infection.

Biopsy↗

PubMed1996

Clinical amnionitis and endometritis in patients with premature rupture of membranes: endocervical prostaglandin E2 gel versus oxytocin for induction of labor.

OBJECTIVE: To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor. METHODS: We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. RESULTS: The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant. CONCLUSION: Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Administration, Topical↗

PubMed2005

Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery.

OBJECTIVE: This study was undertaken to determine whether endometrial microbial colonization or plasma cell endometritis is increased after spontaneous versus indicated preterm delivery or a spontaneous term delivery. STUDY DESIGN: Postpartum, endometrial specimens were obtained after a spontaneous (mean 83, +/- 17.6 days) or indicated (mean 83, +/- 16.7 days) preterm delivery before 34 weeks' gestation and after a spontaneous term delivery (mean 82, +/- 15.7 days; P=.980). Cultures for aerobic and anaerobic bacteria, Trichomonas vaginalis, and genital mycoplasmas were performed. Histologic endometritis was defined as the presence of plasma cells. RESULTS: The study population (n=820) was 71% black, 29% white, 69% unmarried, and 31% had less than 12 years of education. Endometrial cultures were positive for at least 1 microorganism in 82% of the women. No significant difference in positive endometrial cultures were observed among women after a spontaneous versus an indicated preterm delivery (85% vs 79%, P=.102), or a spontaneous preterm versus a spontaneous term delivery (85% vs 81%, P=.123). Plasma cell endometritis was present in 39% of 506 specimens sufficient for histologic examination and was also similar in the three groups (P=.160). CONCLUSION: Microbial colonization of the endometrium and plasma cell endometritis are similar 3 months after spontaneous or indicated preterm or term births. Therefore, chronic infection and inflammation of the endometrium (documented at 3 months postpartum) do not appear to be risk factors for subsequent delivery in women with a prior spontaneous delivery less than 34 weeks' gestation.

Cervix Uteri↗

PubMed2006

Breeding-induced endometritis in mares.

Endometritis is a common cause of infertility in broodmares. In the past, the condition was believed to be exclusively the result of bacterial contamination of the uterus. Treatment strategies were focused on preventing bacteria from entering the uterus and on treating mares with signs of endometritis with antibiotics. More recent research on uterine defense mechanisms has increased our understanding of the pathophysiology of equine endometritis. Additional causative agents have been identified, and we have learned to separate uterine infections and a physiologic breeding-induced endometritis resulting from uterine exposure to semen.vi

Animals↗

PubMed2004

Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding.

OBJECTIVES: To compare the effect of manual removal and spontaneous delivery of placenta on postcesarean bleeding and endometritis. METHODS: In this prospective study 400 pregnant women undergoing elective cesarean delivery were randomly assigned to two groups: spontaneous placental delivery (200 women) and manual placental delivery (200). No antibiotic prophylaxis was administered in either group. The significance of blood loss due to cesarean delivery was defined by a drop in hemoglobin concentration of more than 1 g/dl 24 h after delivery in comparison with preoperative hemoglobin concentration. Endometritis was diagnosed in patients who developed clinical signs of fever and suprapubic tenderness 48 h after delivery. We analyzed the data using a t-test. RESULTS: The overall endometritis rate was 27%, in 40 women in the spontaneous placental delivery group (20%) and 68 women in the manual placental removal group (34%). There was a statistically significant difference between the two groups (P=0.001). Significant blood loss was experienced by 52 women (26%) in the spontaneous placental delivery group vs. 100 women (50%) in the manual placental delivery group. There was a statistically significant difference in blood loss between the two groups (P=0.000; RR=1.92). CONCLUSION: Endometritis and blood loss in cesarean delivery is increased by manual removal of the placenta compared with the spontaneous method of placental removal.

Adult↗

PubMed1998

Is there an association between water baths during labor and the development of chorioamnionitis or endometritis?

OBJECTIVE: Our purpose was to determine whether water baths during labor are associated with the development of chorioamnionitis or endometritis. STUDY DESIGN: One hundred ten cases of chorioamnionitis or endometritis and 97 controls were identified among singleton term gestations from the University of California at San Francisco perinatal database. Medical record review and patient interviews provided information on membrane rupture, history of bathing during labor, and relaxation and pain relief perceived by patients who experienced water bathing during labor. RESULTS: There was no statistically significant association between water baths during labor and the occurrence of chorioamnionitis or endometritis (odds ratio 0.93 [95% confidence interval 0.53 to 1.63]). CONCLUSIONS: Water baths during labor are not associated with chorioamnionitis or endometritis.

Adult↗

PubMed2001

Adjunctive intravaginal metronidazole for the prevention of postcesarean endometritis: a randomized controlled trial.

OBJECTIVE: To estimate the efficacy of preoperative administration of intravaginal metronidazole for the prevention of postcesarean endometritis. METHODS: This double-masked, placebo-controlled randomized trial included patients of at least 24 weeks' gestation undergoing cesarean deliveries for various indications. Patients were randomized to receive either 5 g of metronidazole gel intravaginally or matching placebo before the initiation of the cesarean. All patients underwent surgical cleansing of the abdomen, and most received prophylactic antibiotics after cord clamping. Patients with chorioamnionitis and/or suspected allergy to metronidazole were excluded. For a two-sided alpha of 0.05 and beta of 0.20 (80% power), 120 subjects were required in each group. The main outcome variable was the incidence of postcesarean endometritis. Secondary outcome variables included presence of febrile morbidity, wound infection, days on antibiotics, and length of postpartum hospitalization. Neonatal outcomes included birth weight, Apgar scores less than 7 at 5 minutes, umbilical arterial pH less than 7.16, admission and length of stay in the neonatal intensive care unit, and length of hospital stay. RESULTS: Of 112 patients receiving metronidazole, eight (7%) developed postcesarean endometritis, compared with 19 of 112 (17%) of those receiving placebo gel (relative risk 0.42, 95% confidence interval 0.19, 0.92). No significant differences were noted between treatment groups with respect to the other outcome variables. CONCLUSION: The preoperative administration of 5 g of intravaginal metronidazole gel appears to reduce the incidence of postcesarean endometritis.

Administration, Intravaginal↗

PubMed2002

Association between Mycoplasma genitalium and acute endometritis.

Up to 70% of cases of pelvic inflammatory disease do not have a known cause. We recruited 115 women who had presented to a clinic for sexually transmitted diseases in Nairobi, Kenya with pelvic pain that had persisted for 14 days or less, to look for an association between Mycoplasma genitalium and endometritis. With PCR, we detected M genitalium in the cervix, endometrium, or both in nine (16%) of 58 women with histologically confirmed endometritis and in one (2%) of 57 women without endometritis (p=0.02). Our results suggest that infection with M genitalium is strongly associated with acute endometritis in this population.

Acute Disease↗

PubMed1999

Comparison of a conventional reproductive management programme based on rectal palpation and uterine treatment of endometritis with a strategic prostaglandin F2 alpha programme.

Two reproductive management programmes were implemented on a dairy farm with 780 cows in milk to compare their effects on reproductive efficiency and endometritis. The herd was divided into two groups. All cows in Group 1 received 0.15 mg of D-cloprostenol (Preloban, Hoechst Roussel Vet, Wiesbaden) intramuscularly (i.m.) at 14-day intervals starting at 22-28 days postpartum (pp) until breeding. Group 2 was examined by rectal palpation twice during the third and fifth weeks pp, respectively. Cows that showed signs of endometritis were treated with a uterine infusion of 720 mg polycondensated m-cresolsulphuric acid-formaldehyd (14:1) in 150 ml of water (Lotagen, 2%, Essex Tierarznei, München). For both groups, the voluntary waiting period was set at 50 days pp. Cows were bred on observed oestrus. Cows not bred until day 71 pp were examined by rectal palpation and treated according to a predefined protocol. Group 1 had a higher service rate, and reduced days to first service (P < 0.05) and days open (7.6 days, P = 0.08). First service conception rate and total conception rate were lower than in Group 2 (P < 0.05) and first service conception rate was considerably lower than second service conception rate in Group 1 (P < 0.01). Days open were 4.5 days higher and conception rates were lower in cows with endometritis than in cows without endometritis at post-partum examination (P > 0.05). Results indicate that reproductive management programmes based on strategic use of prostaglandin F2 alpha present an alternative to conventional reproductive management programmes based on rectal palpation and uterine infusions in large dairy herds.

Animals↗

PubMed2001

Endometritis in she donkeys in Egypt.

The endometrial necropsies of 165 she donkeys were examined and the endometria were classified into four grades according to histological features (I, IIa, IIb, III). Category I was observed in 86 cases (52.12%) and diagnosed as normal endometria. Category IIa was observed in 18 cases (10.91%) and diagnosed as slight endometritis. Category IIb was observed in 28 cases (16.97%) and diagnosed as moderate endometritis (two to four nests/field), while category III was observed in 33 cases (20%) and diagnosed as severe endometritis (eight nests/field). A bacteriological examination was carried out and oestrogen and progesterone were estimated. Our results indicate that endometritis and the prognosis of fertility in she donkeys were more or less parallel to mares.

Animals↗

PubMed2001

Clinical and bacteriological aspects on the use of oxytetracycline and flunixin in primiparous cows with induced retained placenta and post-partal endometritis.

Retention of the fetal membranes and post-partal endometritis (RFM) are common problems in dairy cows. Treatment often includes manual removal of the placenta in combination with antibiotic treatment. Earlier studies have shown that cows with endometritis post-partum have a strong tendency to recover spontaneously. The present study focused on treatments of post-partal endometritis with the prostaglandin synthesis inhibitor, flunixin (F) either alone or combined with oxytetracycline (T). The study was conducted in two experiments, using 12 primiparous cows in each. As a model for RFM, premature parturition was induced in late pregnant heifers by injecting PGF2alpha (25 mg i.m.) twice with a 24 h interval. In each experiment the cows were set into four groups and treated with either T (10 mg/kg BW i.m. once daily), F (2.2 mg/kg BW p.o. twice daily), a combination of T and F (dosage, as above) or conservatively (group 0, no drugs). The treatment periods lasted from days 11-14 post-partum in experiment I (groups T1, F1, TF1 and 0) and from days 3-6 post-partum in experiment 2 (groups T2, F2, TF2 and 0). Jugular vein blood samples were collected for analyses of flunixin and total white blood cells. Uterine biopsies were collected twice weekly for investigation of endometrial microbiology. Rectal palpation and ultrasonographic examinations were performed three times weekly for investigations of uterine involution and ovarian activity. No attempts were made to remove the placentas manually. The experiment lasted until day 56 post-partum. The induction of parturition was successful in all heifers and 22 of 24 animals had RFM. All RFM cows had bacterial endometritis. The predominant bacteria were Escherichia coli alpha-haemolytic streptococci, Fusobacterium necrophorum, Arcanobacterium (Actinomyces) pyogenes, Bacteroides spp., Pasteurella spp. and Proteus spp. Fusobacterium necrophorum and A. pyogenes could be isolated for 3-5 weeks post-partum and E. coli Pasteurella and Proteus could be isolated for 2-3 weeks post-partum. Animals treated with tetracycline after placental shedding (T1 and TF1) had a more rapid recovery from infections with A. pyogenes and F. necrophorum than animals that were not treated with tetracycline. No other genera were affected. Antibiotic treatment before placental shedding (T2 and TF2) did not shorten the uterine infection but altered the bacterial flora, seen as an overgrowth of Proteus spp. (p < 0.05) and increased frequency of Pasteurella (p < 0.05). The alpha-haemolytic streptococci were less common in T2 and TF2 than in other groups (NS). Antibiotic treatment of cows before placental shedding (T2 or TF2, n = 6) postponed detachment of placenta compared to cows were no antibiotics were administered before placental shedding (T1, TF1, F1, F2 and 0, n = 16. 9.8 days pp (median) versus p = 0.004). Neither treatment shortened uterine involution. Flunixin treatments did not seem to influence recovery from infection or uterine involution. It was concluded that early oxytetracycline treatment of retained fetal membranes in the cow did not shorten the uterine involution or uterine infection but it did slow down the detachment process of the retained placenta. Oxytetracycline treatment after placental shedding might shorten the uterine infection but otherwise did not affect the clinical results. Flunixin treatment had no influence on the clinical outcome of the disease.

Administration, Oral↗

PubMed2002

15-Ketodihydro-PGF(2 alpha), progesterone and uterine involution in primiparous cows with induced retained placenta and post-partal endometritis treated with oxytetracycline and flunixin.

Retention of the foetal membranes (RFM) and post-partal endometritis are common problems in dairy cows. Among other things, the disease is characterized by a bacterial endometritis with aerobic as well as anaerobic bacteria. From an endocrine perspective, cows with RFM have high levels of 15-ketodihydro-PGF(2 alpha) (PG-metabolite) immediately after parturition but these levels fall rapidly within 2 weeks post-partum (early PG-metabolite elevation). After this decline, the PG-metabolite levels increase again and the levels (at this time of a lower magnitude) remain elevated during the period of uterine infection (late PG-metabolite elevation). The aim of this study was to investigate the PG-metabolite profiles in cows with retained placenta and post-partal endometritis treated with the prostaglandin synthesis inhibitor flunixin (F), either alone or in combination with oxytetracycline (T). The study was accomplished over 2 years with 12 primiparous cows in each experiment. As a model for RFM, preterm parturition was induced in late-pregnant heifers by injecting PGF(2 alpha) (25 mg i.m) twice with a 24 h interval. In each experiment, the cows were divided into four groups and treated with either T (10 mg/kg b.w. i.m. once daily), F (2.2 mg/kg b.w. p.o. twice per day), a combination of T and F (dosage, as above), or conservatively (0). The treatment periods lasted from day 11 to day 14 post-partum (pp) in experiment 1 (after placental shedding, groups T1, F1, TF1 and 0) and from day 3 to day 6 pp in experiment 2 (before placental shedding, groups T2, F2, TF2 and 0). Jugular vein blood samples were collected for analyses of PG-metabolite and flunixin. Uterine biopsies were collected twice weekly for investigation of endometrial microbiology. Rectal palpation and ultrasonographic examinations were performed three times per week for investigations of uterine and cervical involution and ovarian activity. No attempts were made to remove the placentas manually. The experiment lasted until day 56 pp. The induction of parturition was successful in all heifers and 22 of 24 animals had RFM. All RFM cows had bacterial endometritis, based on bacteriological examinations. Flunixin treatment (F1, TF1, F2 and TF2) suppressed PG-metabolite levels significantly (p=0.006) during the period of treatment in both experiments. However, the early flunixin treatment only suppressed PG synthesis partially. Late oxytetracycline treatment (T1) did not influence the PG-metabolite levels but oxytetracycline treatment (T2 and TF2) before placental shedding significantly altered the kinetics of the early PG-metabolite elevation compared with other treatments. Late PG-metabolite elevation was significantly correlated to duration of uterine infection and cervical involution. In conclusion, flunixin treatment of cows with retained placenta either before or after placental shedding suppresses prostaglandin synthesis. However, early treatment, when the release of prostaglandins is high, might need more intensive treatment in order to prevent the PG synthesis effectively. Oxytetracycline treatment during the period immediately after parturition before placental shedding might influence the PG-metabolite profile and suggests a bacteriological contribution to the high levels of PG-metabolite seen during the first 2 weeks pp in cows with retained placenta. In this study, a correlation between prostaglandin release, the final cervical involution and the end of infection was found. This suggests a link between uterine endocrinology, bacteriology and involution in cows with retained placenta.

Animals↗

PubMed2001

Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease.

OBJECTIVE: Careful detection and treatment of pelvic inflammatory disease are essential for the prevention of adverse sequelae. The purpose of this study was to evaluate the diagnostic test characteristics of clinical criteria for the diagnosis of pelvic inflammatory disease. STUDY DESIGN: We performed a cross-sectional analysis of the baseline characteristics of 651 patients enrolled in a multicenter randomized treatment trial for pelvic inflammatory disease. Clinical and laboratory findings were recorded for all patients, and endometrial sampling was performed. We calculated sensitivity and specificity and performed receiver operating characteristic curve analysis and multivariate logistic regression, using histologic endometritis as the criterion standard. RESULTS: The minimal criteria for pelvic inflammatory disease, as recommended by the Centers for Disease Control and Prevention, had a sensitivity of 83%, in comparison with a 95% sensitivity for adnexal tenderness (P =.001). Of the supportive clinical criteria, the finding most highly associated with endometritis was a positive test result for Chlamydia trachomatis or Neisseria gonorrhoeae (adjusted odds ratio, 4.3; 95% confidence interval, 2.89--6.63). A multivariate logistic regression model indicated that combinations of criteria significantly improve the prediction of endometritis. CONCLUSION: Sensitivity can be maximized by using the presence of adnexal tenderness as a minimal criterion for the diagnosis of pelvic inflammatory disease, and supportive criteria are helpful in estimating the probability of endometritis.

Adnexa Uteri↗

PubMedDate not supplied

Predictive value of amniotic-membrane cultures for the development of postcesarean endometritis.

This study assesses (1) the relationship between the bacteriology of amniotic-membrane cultures (AMCs) obtained at the time of primary cesarean section and the subsequent postoperative course of afebrile, laboring patients whose membranes ruptured greater than or equal to 4 hr before delivery and (2) the impact of perioperative antibiotics on this relationship. Therapy with perioperative antibiotics was begun after the cord was clamped and the membrane specimen was obtained for culture. Specimens for AMC were obtained from 127 patients; 62 received placebo and 65 received perioperative antibiotics. In spite of the homogeneity of the patients' clinical risk factors, their AMCs demonstrated considerable variation in the degree of bacterial contamination present at the time of cesarean section. The presence of no growth or of low-virulence isolates only in the AMC usually was associated with a benign postoperative course, and therapy with perioperative antibiotics did not significantly decrease the incidence of endometritis associated with these AMC patterns. On the other hand, the presence of a mixture of high- and low-virulence organisms in the AMC or of high-virulence anaerobes only--more specifically, gram-negative anaerobes--was predictive of subsequent postcesarean endometritis only for patients who did not receive perioperative antibiotics, and therapy significantly decreased the incidence of endometritis associated with these AMC patterns. In conclusion, the correlation between specific bacteriologic patterns found in the AMC and the subsequent development of endometritis for patients who did not receive prophylactic antibiotics was better than the correlation based on clinical risk factors alone.

Adolescent↗