Postpartum Necrotizing Myositis of the Uterus

Postpartum cndometritis is often a mild to moderate infection which responds rapidly to broad spectrum antibiotics. Infrequently, a patient will develop diffuse thrombosis of the vasculature of the uterus,, thereby decreasing tissue perfusion. This results in inadequate levels of antibiotic reaching the myometrium of the uterus. A polymicrobial infection can, therefore, become well established and develop into a synergistic necrotizing infection. Note in (A), the enlarged uterus, the gas present in the uterine myometrium, and necrosis of the lower segment. In (B), the gas pattern is diffusely noted throughout the myometrium. The markedly dilated bowel reflects the presence of intra-abdominal sepsis secondary to infected contents spilling from the disruption of the necrotic lower uterine segment. Antibiotic therapy, clindamycin plus gcntamicin plus ampicillin, was ineffective because adequate tissue levels of antibiotics could neither be achieved nor sustained. A total abdominal hysterectomy was performed and the patient subsequently did well. (C) 1997 Wilcy-I,iss, Inc.