Streptococcus agalactiae pyometra following eutocic vaginal delivery. Case presentation and review of the literature
DOI:
https://doi.org/10.18597/rcog.110Keywords:
Post-partum pyometra, endometritis, Streptococcus agalactiaeAbstract
Objective: To analyze a clinical case of rarely ocurring pyometra associated to Streptococcus agalactiae, after vaginal delivery and to review risk factors, diagnosis and treatment.
Materials and methods: Case seen at the San Cecilio University Hospital in Granada (Spain), which provides obstetric and gynecological services to the population of southern Granada and is a referral center for the primary care hospitals of the southern provincial health district. The patient is a 35 year-old woman, parity 4, who assisted to the hospital, ten days ten days after eutocic vaginal delivery, with a clinical picture consistent with pyometra. On transvaginal ultrasound, the uterine cavity appeared occupied by heterogeneous content. Dilatation and curettage were performed with retrieval of abundant purulent material, and treatment with broad-spectrum antibiotics was instituted. The culture was positive for Streptococcus agalactiae. Pyometra reappeared at a later date, requiring drainage and intravenous treatment with clyndamicin and imipenem, with a good outcome. A literature search was conducted in the Pubmed, Cochrane and UpToDate databases using the terms pyometra, post-partum, endometritis,Streptococcus agalactiae.
Results: Of 833 articles found in the databases, 40 with cases of pyometra or postpartum endometritis in humans were selected. Of these, 14 articles were finally selected, including 3 that described clinical cases and 11 topic reviews.
Conclusions: The occurrence of pyometra after eutocic vaginal delivery is rare in humans, but must be considered as a potential etiology in cases of post-partum fever with associated risk factors. The diagnosis is based on good clinical and ultrasound examination, and the condition requires early treatment with broad-spectrum antibiotics and drainage.
Author Biographies
Rosario Redondo-Aguilar
Mariam Abulhaj-Martínez
Milagros Cruz-Martínez
Esther Hidalgo-Carmona
Carmen Padilla-Vinuesa
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