P11.18: Sonography of severe post‐caesarean endometritis requiring hysterectomy

Post-caesarean endometritis is the most common cause of fever during the postpartum period. Severe intractable endometritis requiring hysterectomy is a rare but potentially life-threatening complication. The aim of our study was to describe the sonographic findings associated with this entity. Vaginal sonography was performed in three patients with severe post-caesarean endometritis eventually requiring hysterectomy and in 19 control patients between 3 to 4 weeks after caesarean section. The three patients with endometritis had an uneventful post-caesarean course and were only readmitted after 15 to 19 days because of fever and pain. In all cases vaginal sonography demonstrated similar findings including a large soft uterus with a fluid collection in the endometrial cavity that had an irregular lining. Following the hysterectomy that was eventually performed due to the worsening of the general conditions despite multi-agent antibiotic treatment, pathology showed diffuse inflammatory infiltration of the myometrium, vascular ectasia, and areas of necrosis. In the control group, 4/19 patients had a little amount of fluid in the endometrial cavity. In patients with a suspicious clinical picture, the presence of fluid in the endometrial cavity increases the likelihood of severe endometritis. The irregularity of the endometrial cavity, the slightly enlarged size and the soft appearance of the uterus add to the index of suspicion.