Endometritis is an inflammatory disease that affects the inner layer of the uterus (endometrium).
Endometritis is a common gynecological disease and in 90% of cases it is diagnosed in women of reproductive age.
When inflammation of the uterus mucous membrane infection will inevitably spread to the muscle layer, so it is more expedient to talk about endomyometritis.
As the process progresses, acute, subacute and chronic endometritis is isolated.
A separate graph should be rendered postpartum endometritis. Endometritis after birth takes the first place among purulent-inflammatory postpartum complications (about 40%).
According to the severity of the disease, endometritis can be mild, moderate or severe.
The cause of endometritis are pathogenic microorganisms, not only bacteria, but also viruses, protozoa and fungi:
- E. coli;
- chlamydia and mycoplasma;
- Mycobacterium tuberculosis;
- yeast-like mushrooms;
- Trichomonas and others.
Infection, which causes inflammation of the uterine mucosa, gets into it due to mechanical damage to the endometrium and reduced protective forces of the body. Predisposing factors include:
- intrauterine manipulations (uterus sounding, IUD installation, diagnostic curettage, abortions, miscarriages, hysteroscopy , metrosalpingography );
- complicated childbirth ( weakness of labor activity , weakness of attempts, bleeding in the afterbirth period, a long anhydrous period – more than 12 hours, cesarean section);
- lack of personal hygiene and sexual intercourse during menstruation;
- violation of the douching procedure;
- the remains of the ovum after an abortion or the remains of the afterbirth after childbirth
Chronic endometritis occurs as a result of untreated or inadequately treated acute endometritis.
Acute endometritis begins with a sudden increase in temperature to febrile numbers (39.0 – 40.0 ° C), chills alternate with fever, sweating increases, signs of general malaise (weakness, lack of appetite, fatigue) appear.
Characterized by acute pain in the lower abdomen or spasms in the presence of a foreign body: IUD, remnants of the afterbirth / ovum.
Pain can be given to the lower back and sacrum.
The discharge from the genital tract in the acute course of the disease is abundant, serous-purulent or bloody, the color of “meat slop” with an unpleasant odor.
In the presence of residues of the ovum, possible bleeding is possible.
The clinical picture of the chronic process is blurred.
The patient complains of a constant subfebrile temperature (37, 1 – 37.8 ° C).
Chronic endometritis is characterized by constant aching pain in the lower abdomen, radiating to the sacrum and lumbar region. Also, there is a violation of the menstrual cycle (pre-and postmenstrual bleeding, bleeding in the middle of the cycle), which is associated with hormonal disorders, impaired transformation of defective endometrium, increased vascular permeability and pathology of the uterus contractile function.
Chronic process is accompanied by weakness, fatigue, impaired psycho-emotional state.
Possible pain during intercourse ( dyspareunia ) and bowel movements. 50% of patients have problems with conceiving and carrying a pregnancy.
Postpartum endometritis develops 3 to 5 days after delivery or cesarean section. Symptoms of postpartum endometritis are the same as signs of the acute form.
Differential diagnosis of endometritis is carried out with adnexitis (inflammation of the appendages), ectopic pregnancy , appendicitis and parametritis (inflammation of the circulatory tissue).
- Collecting anamnesis and complaints. Recently performed intrauterine interventions, the course of labor and the postoperative period (after cesarean section or abortion) are being investigated.
- Gynecological examination. When conducting a gynecological examination palpable uterus and appendages. In acute endometritis, a softened, enlarged and painful uterus is determined, in a chronic process, the uterus is thickened, somewhat more than normal, sensitive to palpation and displacement beyond the cervix. The nature of the discharge is evaluated (color, quantity, smell).
- Vaginal smears on the microflora. Smears from the cervical canal and the vagina are examined to identify pathogenic microorganisms and assess the degree of purity. Bacteriological culture of secretions on nutrient media is carried out in order to identify the pathogen. According to the indications, additional tests for sexually transmitted infections (chlamydia, mycoplasmosis, cytomegalovirus and others) are prescribed.
- General clinical blood and urine tests. In general, a blood test revealed an increase in ESR , an increase in the number of leukocytes with a shift of the leukocyte formula to the left. In chronic endometritis there is a decrease in platelets , which indicates a violation of blood clotting, possibly a decrease in hemoglobin (anemia).
- Ultrasound of the pelvic organs . During an ultrasound, uteri and appendages are evaluated. The size of the uterus and its cavity, the presence of blood clots, pus, fetal egg residues or synechiae (intrauterine adhesions), endometrial thickness (M-echo), its correspondence to the phase of the menstrual cycle are determined.
- Hysteroscopy . Uterine examination with a hysteroscope is carried out in cases of suspected chronic endometritis, according to indications endometrial sampling (endometrial biopsy) is performed for further histological examination.
Treatment of patients with acute endometritis and chronic exacerbation is carried out in a hospital. Therapy is prescribed and monitored by a gynecologist.
First of all, antibiotics are prescribed intramuscularly or intravenously (depending on the severity of the disease). Antibiotic therapy is selected taking into account the pathogen of endometritis sown. Preference is given to cephalosporins ( kefzol, ceftriaxone, cefotaxime ) and fluoroquinolones (ciprofloxacin, clindamycin ).
Often practiced by the combined appointment of antibiotics from different groups. In addition, metronidazole must be prescribed in tablets or intravenously ( metrogil ), which suppresses anaerobic flora.
Against the background of antibiotics, antifungal drugs ( pimafucin, clotrimazole, diflucan ) are used to prevent vaginal candidiasis and intestinal dysbiosis.
In order to detoxify and reduce the temperature, infusion therapy is prescribed (physical solution, glucose solution intravenously).
Additionally, non-steroidal anti-inflammatory drugs are used ( indomethacin , diclofenac tablets and suppositories), which have an anti-inflammatory and analgesic effect. The administration of vitamins and the correction of immunity by immunomodulating drugs ( Taktivin, thymalin ) are shown .
The treatment lasts 7-10 days.
After stopping the acute period and in case of chronic endometritis without exacerbation, physiotherapy is recommended (UHF on the lower abdomen, electrophoresis with lidaza or copper and zinc in the phases of the menstrual cycle, SMT, etc.). Patients with chronic endometritis are prescribed oral hormonal contraceptives (to restore the menstrual cycle) for 3-6 months.
Surgical intervention (curettage of the uterus) is carried out in the presence of residues of the ovum or parts of the placenta, hematometers (blood stagnation in the uterus with the “closed” neck). If synechiae are found in the uterus, they are separated and excised during hysteroscopy.
Possible complications of endometritis include:
- adnexitis (spread of infection to the uterus);
- thrombophlebitis of the pelvic and lower extremity veins;
- violation of the menstrual cycle;
- habitual miscarriage;
- pelvic pain syndrome (constant aching pain in the abdomen for no apparent reason).
The prognosis for acute endometritis is favorable. With adequate treatment and prophylactic courses, pregnancy occurs in 90% of cases of chronic endometritis.