00:00 / 00:00




Reproductive system




0 / 6 complete

USMLE® Step 1 questions

0 / 1 complete



of complete


USMLE® Step 1 style questions USMLE

of complete

A 28-year-old woman, gravida 1 para 1, presents to the emergency department with complaints of lower abdominal pain and foul-smelling vaginal discharge. She gave birth to a healthy female newborn 2 days ago. Vaginal delivery was converted into emergency cesarean section due to obstructed labor, and the placenta was removed manually. Past medical history is significant for pre-gestational diabetes mellitus type II as well as Neisseria gonorrhoeae cervicitis when the patient was 19, for which she was treated appropriately. Temperature is 101.4°F (38.5 °C), pulse is 100/minute, respirations are 19/minute, and blood pressure is 100/60 mmHg. BMI is 33 kg/m2. On physical examination, there is mild peri-incisional tenderness, minimal discharge at the surgical site, and no erythema or edema around the incision site. Foul-smelling greenish-yellow lochia is observed in the vaginal vault. Bimanual examination shows cervical motion and uterine tenderness. Complete blood profile shows hemoglobin of 12 g/dL and leukocyte count of 18,000/mm3. Which of the following is the most likely diagnosis?  

External References

First Aid









endometritis p. 665


endometritis after p. 665


endometritis p. 665

Endometritis p. 665

Gentamicin p. 184, 188

endometritis p. 665

Intrauterine device (IUD)

endometritis p. 665


Content Reviewers


Endometritis is an inflammation of the endometrium, which is the inner lining of the uterus.

It is usually caused by an infection of the endometrium from bacteria that normally live in the female lower genital tract, but it could also be caused by bacteria from outside the body.

The female reproductive system is divided into upper and lower genital tracts.

The upper genital tract consists of the uterus, ovaries, and fallopian tubes.

The lower genital tract in turn consists of the cervix, vagina and the external genitals, which includes the labia and the clitoris.

Now, The uterus consists of 3 layers, an outer thin layer called the perimetrium or the serosa, a middle smooth muscle layer called the myometrium, and the innermost layer, the endometrium.

The endometrium has two layers, an inner functional layer made up mainly of glands and supporting connective tissue, called stroma, and an outer thin basal layer which regenerates the overlying functional layer after each menstrual cycle.

Alright, normally, there are many species of bacteria living in the female’s lower genital tract, and this is called the normal flora.

These include Ureaplasma urealyticum, Peptostreptococcus and group B Streptococcus.

Under normal conditions, these bacteria live there happily without causing any harm, however, if they reach the upper genital tract, they can cause an infection like endometritis if they make it to the uterus.


Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. It is usually caused by normal flora of the genital tract if the endometrium is breached, but can also be caused by sexually transmitted infections, such as Chlamydia trachomatis and Neisseria gonorrhoeae infections.

Common symptoms are fever, pain in the pelvis or lower abdomen, abnormal vaginal discharge, and painful sexual intercourse. Procedures which can lacerate the endometrium such as childbirth, abortion, surgery on the uterus or other pelvic organs, and insertion of an intrauterine contraceptive device (IUD), all increase a chance of having endometritis.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "An in vitro study of antibacterial properties of the cervical mucus plug in pregnancy" American Journal of Obstetrics and Gynecology (2001)
  6. "The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology" American Journal of Obstetrics and Gynecology (2018)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.