A protected, triple-lumen transcervical culture method was used to recover organisms from the endometrium. At least one facultative or one anaerobic species of bacteria was recovered from 82% of the patients, and genital mycoplasmas were recovered from 76% of the women with endometritis. Bacteria together with genital mycoplasmas were present in 61% of the women, bacteria alone were present in 20%, genital mycoplasmas alone were present in 16%, and Chlamydia trachomatis was isolated from 2% of the patients. The most common organisms included Gardnerella vaginalis, Peptococcus spp., Bacteroides spp., Staphylococcus epidermidis, group B Streptococcus, and Ureaplasma urealyticum. A randomized, double-blind regimen of either piperacillin or cefoxitin was equally successful in treating the postpartum endometritis.

Twelve women, aged 16 to 29 years, were interviewed and examined for possible neuropsychological sequelae 2 to 12 months after they recovered from toxic shock syndrome. Six of the 12 women had symptoms such as difficulty concentrating, headache, recent memory lapses, inability to compute, and loss of other higher integrative functions. Eight patients were found to have electroencephalographic abnormalities. All six symptomatic patients but no asymptomatic patients had abnormal neurologic findings. Abnormalities such as impaired memory and calculation and poorly sustained concentration were found in five of six symptomatic patients but in no asymptomatic patient. Six control subjects, all asymptomatic women aged 17 to 29 years, were interviewed and examined 2 to 12 months after they recovered from postpartum endometritis; these subjects were normal in all parameters tested. A direct effect of the staphylococcal toxin on the central nervous system may be the cause of these sequelae.

Transfundal endometrial cultures obtained from afebrile women who delivered vaginally were uniformly free of bacteria and contained Ureaplasma urealyticum in only 2 of 14 women. A protected triple-lumen transcervical method to obtain an endometrial culture recovered organisms from 6 (43%) of the 14 women. Compared with cultures from afebrile women, organisms were recovered from 51 (93%) of 55 febrile postpartum women by using the triple-lumen transcervical culture method (P less than .001). Among febrile women there was a correlation between the recovery of group B Streptococcus, enterococcus, Gardnerella vaginalis, Staphylococcus aureus, and anaerobic bacteria from the cervix and their recovery from the endometrium. Protected transcervical methods used to obtain postpartum endometrial cultures reduce cervical contamination, but semiquantitation of the culture is useful to further increase culture specificity.

Pregnancy does not increase the percentage of activated platelets in the circulation. Platelet reactivity is altered in the third trimester, as evidenced by decreased antibody binding to fibrinogen receptor epitope and enhanced down-regulation of a von Willebrand factor receptor epitope.