Postpartum endometritis and infection following incomplete or complete abortion

Need for developing case definitions and guidelines for data collection, analysis, and presentation for postpartum endometritis and infection following incomplete or complete abortion as adverse events following maternal immunization
Remarkable progress has been made in the implementation of vaccinations against infectious diseases worldwide. Immunization of pregnant women is important because pregnancy is thought to modulate the immune system to tolerate a growing fetus, and this, along with the physiologic changes of pregnancy, may increase susceptibility to certain infectious diseases [1]. Immunizing the mother also provides direct protection via transplacental transfer of antibodies for the fetus during pregnancy and for the neonate following delivery. Pregnancy outcomes related to the administration of immunizations during pregnancy, however, have been less well studied. In particular, puerperal sepsis (infection of the female genital tract following childbirth or abortion/miscarriage) has not been well studied following maternal immunization. Puerperal sepsis is responsible for over 10% of maternal deaths worldwide and disproportionately occur in low- and middle-income countries (LMICs) [2], [3]. Puerperal sepsis is defined by the World Health Organization (WHO) as infection of the genital tract occurring any time between the rupture of membranes or labor and the 42nd day postpartum. This definition encompasses both chorioamnionitis and postpartum endometritis or endomyometritis (PPE), two of the most common infections surrounding childbirth [4]. These complications are likely to be inconsistently reported. ICD-10 codes for “sepsis following incomplete or complete abortion” (O03.87) and “endometritis following delivery” (O86.12) do not include any diagnostic criteria.

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