Faure K, Dessein R, Vanderstichele S, Subtil D
Service des maladies infectieuses, University Lille, CHU Lille, 59000 Lille, France; Recherche translationnelle relations hôte-pathogènes, EA 7366, University Lille, 59000 Lille, France.
Recherche translationnelle relations hôte-pathogènes, EA 7366, University Lille, 59000 Lille, France; Service de bactériologie hygiène, University Lille, CHU Lille, 59000 Lille, France.
Gynecol Obstet Fertil Senol. 2019 May;47(5):442-450. doi: 10.1016/j.gofs.2019.03.013. Epub 2019 Mar 16.
Postpartum endometritis accounts for 2% of postpartum infections in developed countries. In France, 2.3% of deaths are attributed to puerperal infections. The most important risk factor is cesarean delivery, especially if it is done after the start of labor. Bacteria of the vaginal microbiota are associated with postpartum endometritis. Symptoms are abdomino-pelvic pain, hyperthermia and abnormal lochia. The diagnosis is confirmed by uterine mobilization pain. The first-line antibiotic therapy is amoxicillin-clavulanic acid 3 to 6 grams per day depending on the weight, intravenously or orally. In case of impossibility to use penicillins (anaphylaxis for example), the combination of clindamycin 600mg×4/d plus gentamicin 5mg/kg×1/d may be use, it must be a specialized decision in case of maternal breastfeeding. The treatment is continued until obtaining 48hours of apyrexia and the disappearance of pelvic pain. In case of persistence of fever and/or pelvic pain after 72hours of antibiotic therapy, pelvic imaging should be performed for placental retention, septic thrombophlebitis, deep abscess or any other surgical complication and eliminate differential diagnoses. It is important to highlight the difficulties of interpreting endo-uterine images in ultrasound. Hypocoagulant heparin therapy should be started in case of septic thrombophlebitis for 6 weeks, or longer if there are complications such as embolism or thrombotic risk factors. Regarding prevention, during a caesarean section, a vaginal swab with iodinated polividone or chlorhexidine is recommended before caesarean if possible, and extraction of the placenta must be spontaneous.
在发达国家，产后子宫内膜炎占产后感染的2%。在法国，2.3%的死亡归因于产褥期感染。最重要的危险因素是剖宫产，尤其是在临产开始后进行的剖宫产。阴道微生物群的细菌与产后子宫内膜炎有关。症状包括腹盆腔疼痛、发热和恶露异常。通过子宫活动疼痛可确诊。一线抗生素治疗是阿莫西林-克拉维酸，根据体重每天3至6克，静脉或口服给药。如果无法使用青霉素（例如过敏反应），可使用克林霉素600mg×4/天加庆大霉素5mg/kg×1/天的联合用药，但在产妇母乳喂养的情况下这必须是一个专业的决定。治疗持续至体温正常48小时且盆腔疼痛消失。如果抗生素治疗72小时后仍持续发热和/或盆腔疼痛，应进行盆腔影像学检查以排除胎盘残留、脓毒性血栓性静脉炎、深部脓肿或任何其他手术并发症，并排除鉴别诊断。必须强调超声检查中解读子宫内图像的困难。对于脓毒性血栓性静脉炎，应开始使用低凝肝素治疗6周，如果有并发症如栓塞或血栓形成危险因素，则治疗时间更长。关于预防，在剖宫产时，如果可能，建议在剖宫产术前用聚维酮碘或氯己定进行阴道拭子检查，并且胎盘必须自然娩出。
