Endometritis Following Pregnancy: A Comparative Cohort Study of Cases With and Without RPOC

This study aimed to compare the clinical course, management, and outcomes of women diagnosed with endometritis following delivery or abortion, with and without retained products of conception (RPOC).

A retrospective cohort study was conducted at a single tertiary medical centre between 2012 and 2023. Women admitted with a diagnosis of endometritis or pelvic inflammatory disease following delivery or abortion were identified and divided into 2 groups based on the presence or absence of RPOC. Clinical presentation, laboratory results, antibiotic treatment, need for surgical intervention, and severe complications were compared between groups.

A total of 341 women were included, of whom 32 (9.4%) had RPOC. Baseline laboratory values did not differ significantly between groups. Most patients responded well to empiric antibiotic therapy, and modification of the antibiotic regimen was rare in both groups (0% in RPOC vs. 6.5% in non-RPOC, P = 0.2). Surgical interventions were significantly more frequent in the RPOC group (49% vs. 5.2%, P < 0.001), while severe complications such as intensive care unit admission, sepsis, and hysterectomy were rare in both groups.

Endometritis with RPOC does not necessarily follow a more severe course than endometritis alone. Most patients, regardless of RPOC status, improved with antibiotics alone. These findings support an individualized approach, wherein clinical stability may allow for conservative management of suspected infected RPOC.