What is the strongest risk factor for postpartum endometritis?

The strongest risk factor for postpartum endometritis is a cesarean section. This condition typically arises from the introduction of bacteria into the uterine cavity during or after delivery, and cesarean deliveries involve surgical intervention, which inherently increases the risk of infection due to the opening of the uterus and potential exposure to pathogens.

In contrast, options such as internal fetal monitoring, multiple gestation, and prelabor rupture of membranes are associated with postpartum complications, but they do not carry the same level of risk for endometritis as a cesarean section. Internal fetal monitoring may increase the risk of infection, but it does not involve the invasive surgical procedure that a cesarean section does. Multiple gestation is a risk factor for various complications during childbirth, but it does not significantly elevate the risk of endometritis on its own. Likewise, while prelabor rupture of membranes can potentially lead to infections, particularly if prolonged, the surgical nature and associated factors of cesarean delivery make it a much stronger risk factor for developing postpartum endometritis.