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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Postpartum endometritis and wound infection

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

RapidFull
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Pain and deterioration can precede fever

Postpartum infection with confusion, hypotension, breathlessness, oliguria or disproportionate perineal pain may represent sepsis or necrotising infection, even with a normal temperature.

Action: Arrange emergency hospital assessment, involve senior obstetrics and anaesthesia, obtain urgent cultures and lactate without delaying intravenous antibiotics, and seek immediate surgical assessment when tissue necrosis is possible.

Synopsis

Recognise uterine and birth wound infection after discharge, identify maternal sepsis promptly, and coordinate antimicrobial treatment with drainage or removal of an infected focus.

  • Endometritis is a clinical diagnosis supported by examination and investigations.
  • Inspect the caesarean or perineal wound with consent and adequate analgesia.
  • A small skin opening can conceal a substantial deeper collection.
  • High-risk maternal sepsis needs intravenous antibiotics within one hour.
  • Use the pregnancy-specific NICE fluid pathway during the first six postpartum weeks.
  • Antibiotics cannot compensate for an undrained abscess or necrotic tissue.

Key red flags

Rapidly worsening abdominal or perineal pain with systemic illness.

New confusion, low blood pressure or markedly reduced urine output.

Spreading wound discolouration, skin blistering or crepitus.

Heavy bleeding together with offensive discharge and uterine tenderness.

Investigation priorities

01
Blood cultures and lactateFirst step

Identify bloodstream infection and assess impaired perfusion promptly.

Management branches

CommunityEscalate a symptomatic postpartum contact

New pelvic pain discharge or wound symptoms develop after discharge.

  1. Assess the severity immediately and arrange emergency transport for physiological compromise or rapidly advancing pain.
  2. Arrange same-day maternity or acute assessment when uterine infection, wound breakdown or a deep collection is suspected.
  3. Send the birth summary, allergy details and recent antibiotic history with a clear account of symptom progression.
Local infectionTreat a stable wound or uterine focus

Examination identifies infection without haemodynamic compromise or urgent surgical features.

  1. Separate superficial incisional cellulitis from uterine or deep genital infection before selecting an antibiotic regimen.
  2. Use local obstetric antimicrobial guidance and organise drainage or wound management when a collection or breakdown is present.
  3. Set a defined review interval and explain that spreading pain, systemic symptoms or failure to improve needs earlier reassessment.

Key medicines

Co-amoxiclav for postpartum endometritisNHS Lothian example: 1.2 g intravenously every 8 hours, switching when appropriate to 625 mg orally every 8 hours; total intravenous plus oral course 7 days.Check immediate penicillin allergy, renal function and previous co-amoxiclav-associated liver injury. Hypotensive sepsis may require additional agents under obstetric and microbiology advice. Confirm the locally approved obstetric antibiotic schedule before prescribing.
Flucloxacillin for uncomplicated superficial cellulitisNICE adult oral regimen: 500 mg to 1 g four times daily for 5–7 days, with clinical review if worsening or failing to improve.Avoid in penicillin hypersensitivity and previous flucloxacillin-associated hepatic injury. Significant systemic illness, abscess or genital tract infection requires a different assessment and potentially broader intravenous treatment.
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Sources and review status6 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • RCOG Green-top guideline 64 maternal sepsis
  • NICE NG255 maternal sepsis antibiotics fluids and oxygen
  • NHS Lothian endometritis antimicrobial prescribing
  • NICE NG141 cellulitis antimicrobial prescribing
  • NICE NG194 postnatal care recommendations
  • RCOG maternal sepsis guideline June 2026 correction

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom