Pathophysiology and management of postcesarean endomyometritis.

Endomyometritis is the most common complication associated with cesarean delivery. The incidence varies from 5 to 85%, depending upon the patient population surveyed. The major risk factors for postcesarean endomyometritis are young age, low socioeconomic status, and extended duration of labor and ruptured membranes. The principal microorganisms responsible for infection are group B streptococci, aerobic gram-negative bacilli, anaerobic gram-positive cocci, and anaerobic gram-negative bacilli. The mean incidence of bacteremia in patients with endomyometritis is 10%. Less than 2% of infected patients develop life-threatening complications such as septic shock, pelvic abscess, or septic pelvic thrombophlebitis. Antibiotics of proved value in treatment of postcesarean endomyometritis include the newer broad-spectrum cephalosporins and ureidopenicillins and the combination regimen of clindamycin plus aminoglycoside.