Dr Maxwel Adeyemi

THE ENDOMETRIUM is the tissue that lines the womb. It is the mucous membrane that thickens in anticipation of a possible pregnancy. If fertilisation occurs and embryo is implanted, the lining stays in place, if not, the endometrium thins and sheds as a menstrual period.

Endometritis is a term used to describe endometrial inflammation (swelling of the lining of the womb), which is caused by an infection. It may occur during the postpartum period as an infection may have been introduced during or after labour and delivery. After childbirth, the uterine lining (endometrium) becomes inflamed. It is a peculiar infection that frequently develops in the first few weeks following delivery.

Causes of postpartum endometritis

Prolonged rupture of the membranes: This condition occurs when a woman's amniotic sac or 'water bag' ruptures or breaks prior to the start of labour and the amniotic fluid leaks over a protracted length of time. The rupturing of the membranes typically happens during the active stage of labour, indicating the beginning of delivery. However, prolonged rupture of membranes is when the amniotic sac ruptures before the start of labour and the amniotic fluid leakage continues for a long time (often longer than 18 to 24 hours). Early membrane rupture opens the door for bacteria from the cervix or vagina to enter the uterus, resulting in infection.

Prolonged labour: The longer the labour, the more exposure the uterus and birth canal have to possible bacteria, which increases the chance of infection. When the cervix opens during labour to let the baby pass through, germs can also enter the uterus through this opening.

Chorioamnionitis: An infection known as chorioamnionitis during pregnancy affects the foetal membranes (chorion and amnion) as well as the amniotic fluid. During labour and delivery, the bacteria that caused this infection may move to the uterine cavity, resulting in endometrial infection.

Caesarean delivery: Despite the fact that C-sections are typically regarded as safe, they do have a higher risk of some problems than vaginal deliveries. The uterus is accessed during a C-section through an incision in the abdomen and uterus. Bacterial contamination at the surgical site is still a potential even when thorough sterile procedures are followed. During the process, bacteria from the skin or the surrounding area may enter the uterus, raising the risk of infection.

Retention or manual removal of placental fragments in the uterus: After delivery, placental pieces that are still in the uterus provide a risk of infection. These retained fragments can get colonised by bacteria from the vagina or the environment, which can cause an infection in the uterine cavity.

Postpartum haemorrhage (PPH): Prolonged and uncontrolled bleeding brought on by PPH can raise the risk of infection by fostering the growth of bacteria. In addition, treatments for PPH that involve manual placenta removal or intensive uterine manipulation may spread bacteria to the uterus, incr