Endometritis
Endometritis is an inflammation or irritation of the endometrium, the inner lining of the uterus, and can extend to surrounding tissues. It is categorized into two types: acute, characterized by the presence of neutrophils, and chronic, marked by plasma cells and lymphocytes. The condition is often caused by microbial infections, originating from normal vaginal bacteria or pathogens like chlamydia and gonorrhea. Risk factors include recent childbirth, particularly cesarean deliveries, as well as medical procedures involving the uterus, such as hysteroscopy.
Common symptoms of endometritis include lower abdominal pain, fever, and abnormal vaginal discharge, which may be foul-smelling. Diagnosis typically involves physical examinations, cervical cultures, and possibly imaging or biopsies. Treatment generally consists of broad-spectrum antibiotics, and in more severe cases, hospitalization may be necessary. Preventive measures focus on maintaining sterile techniques during childbirth and surgical procedures, as well as practicing safer sex to reduce the risk of sexually transmitted infections contributing to endometritis. Understanding this condition is crucial for those who may be at risk, especially during or after pregnancy.
Endometritis
Anatomy or system affected: Reproductive system, uterus
Also known as: Endomyometritis
Definition
Endometritis is an irritation or inflammation of the endometrium, the inner lining of the uterus, that sometimes extends into the myometrium and parametrial tissues. Pathologically, endometritis is classified as acute or chronic. Acute endometritis is distinguished by the presence of neutrophils in the endometrial glands and chronic endometritis is characterized by variable numbers of plasma cells and lymphocytes within the endometrial stroma.
Causes
Endometritis is a microbial infection that can be caused by normal vaginal bacteria and by chlamydia, gonorrhea, chronic pelvic inflammatory disease, or tuberculosis. In most cases, it is initiated by an ascending infection from organisms found in the normal vaginal flora. Infection may be produced by compromised abortions, complicated deliveries, miscarriages, medical exam instrumentation, and retention of placental fragments.
Risk Factors
The risk for endometritis increases after miscarriage or childbirth, particularly after a long labor or a cesarean section. Medical procedures that involve entering the uterus through the cervix such as hysteroscopy and placement of an intrauterine device increase the risk of developing endometritis. After vaginal delivery, incidence is between 1 and 3 percent, whereas for cesarean delivery, incidence ranges from 13 to 90 percent.
Symptoms
The most common symptoms associated with endometritis are lower abdominal pain, fever, and increased vaginal discharge or bleeding. There may be yellow, foul-smelling vaginal discharge. Discomfort with bowel movement and constipation may also occur. Menstruation can be excessive after acute endometritis, but the excessive bleeding can usually be resolved after two weeks of antibiotic treatment. Patients suffering from chronic endometritis may have an underlying cancer of the cervix or endometrium.
Screening and Diagnosis
Physical and pelvic exams will be performed by a health care provider. The lower abdomen, uterus, and cervix may be tender. Cervical discharge and decreased bowel sounds may be present. Cultures may be taken from the cervix to test for microbial infectious agents. Other tests performed often include an endometrial biopsy, laparoscopy, white blood count, and microscopic examination of any vaginal discharge.
Treatment and Therapy
Broad-spectrum antibiotics are used to treat and prevent complications of endometritis. Treatments sometimes involve plenty of rest and administering fluids through a vein. For complicated cases of endometritis, hospitalization may be necessary.
Prevention and Outcomes
The risk of endometritis can be reduced by employing careful, sterile techniques during the delivery of a baby, during an abortion, or during any gynecological procedures. Safer sex practices reduce the risk of endometritis caused by sexually transmitted infections.
Bibliography
Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2006.
Berek, Jonathan S., ed. Berek and Novak’s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
Dallenbach-Hellweg, Gisela, Dietmar Schmidt, and Friederike Dallenbach. Atlas of Endometrial Histopathology. 3d ed. New York: Springer, 2010.
Icon Health. Endometritis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2003.
Katz, V. I., et al., eds. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier, 2007.
Wilson, Walter, and Merle Sande. Current Diagnosis and Treatment in Infectious Diseases. New York: McGraw-Hill Medical, 2001.