| Endometritis | |
|---|---|
| Other names | Postpartum endometritis, endomyometritis |
 | |
| Micrograph showing a chronic endometritis with the characteristicplasma cells. Scatteredneutrophils are also present.H&E stain. | |
| Specialty | Gynaecology,obstetrics |
| Symptoms | Fever, lower abdominal pain, abnormalvaginal bleeding,discharge[1] |
| Types | Acute, chronic[2] |
| Causes | Infectious[2] |
| Risk factors | Abortion,menstruation,childbirth, placement of anIUD,douching[3][2] |
| Treatment | Antibiotics[1] |
| Prognosis | Good with treatment[4] |
| Frequency | 2% (following vaginal delivery), 10% (following scheduled C-section)[5] |
Endometritis isinflammation of the inner lining of theuterus (endometrium).[6] Symptoms may includefever, lower abdominal pain, and abnormalvaginal bleeding ordischarge.[1][4] It is the most common cause ofinfection after childbirth.[7][1] It is also part of spectrum of diseases that make uppelvic inflammatory disease.[8]
Endometritis is divided into acute and chronic forms.[2] The acute form is usually from aninfection that passes through thecervix as a result of anabortion, duringmenstruation, followingchildbirth, or as a result ofdouching or placement of anIUD.[2][3] Risk factors for endometritis following delivery includeCaesarean section andprolonged rupture of membranes.[1] Chronic endometritis is more common aftermenopause.[2] The diagnosis may be confirmed byendometrial biopsy.[3]Ultrasound may be useful to verify that there is no retained tissue within the uterus.[4]
Treatment is usually withantibiotics.[1] Recommendations for treatment of endometritis following delivery includesclindamycin withgentamicin.[9] Testing for and treatinggonorrhea andchlamydia in those at risk is also recommended.[10] Chronic disease may be treated withdoxycycline.[10] Outcomes with treatment are generally good.[4]
Rates of endometritis are about 2% followingvaginal delivery, 10% following scheduled C-section, and 30% with rupture of membranes before C-section if preventive antibiotics are not used.[5] The term "endomyometritis" may be used when inflammation of the endometrium and themyometrium is present.[11] The condition is also relatively common in other animals such ascows.[12]
Symptoms may includefever, lower abdominal pain, and abnormalvaginal bleeding ordischarge.[1][4]
Acute endometritis is characterized by infection. The organisms most often isolated are believed to be because of compromised abortions, delivery, medical instrumentation, and retention of placental fragments.[13] There is very uncertain evidence supporting the use of prophylactic antibiotics to prevent endometritis after manual removal of placental in vaginal birth.[14] Histologically, neutrophilic infiltration of the endometrial tissue is present during acute endometritis. The clinical presentation is typically high fever and purulent vaginal discharge. Menstruation after acute endometritis is excessive and in uncomplicated cases can resolve after 2 weeks ofclindamycin andgentamicinIV antibiotic treatment.
In certain populations, it has been associated withMycoplasma genitalium andpelvic inflammatory disease.[15][16]
Chronic endometritis is characterized by the presence ofplasma cells in the stroma. Lymphocytes, eosinophils, and even lymphoid follicles may be seen, but in the absence of plasma cells, are not enough to warrant a histologic diagnosis. It may be seen in up to 10% of all endometrial biopsies performed for irregular bleeding. The most common organisms areChlamydia trachomatis (chlamydia),Neisseria gonorrhoeae (gonorrhea), Streptococcus agalactiae (Group B Streptococcus),Mycoplasma hominis,tuberculosis, and various viruses. Most of these agents are capable of causing chronicpelvic inflammatory disease (PID). Patients with chronic endometritis may have an underlying cancer of the cervix or endometrium (although infectious cause is more common). Antibiotic therapy is curative in most cases (depending on underlying cause), with fairly rapid alleviation of symptoms after only 2 to 3 days. Women with chronic endometritis are also at a higher risk of pregnancy loss and treatment for this improves future pregnancy outcomes.[17][18]
Chronic granulomatous endometritis is usually caused by tuberculous. The granulomas are small, sparse, and withoutcaseation. The granulomas take up to 2 weeks to develop and since the endometrium is shed every 4 weeks, the granulomas are poorly formed.
In human medicine, pyometra (also a veterinary condition of significance) is regarded as a form of chronic endometritis seen in elderly women causing stenosis of the cervical os and accumulation of discharges and infection. Symptom in chronic endometritis is blood stained discharge but in pyometra the patient complaints of lower abdominal pain.
Pyometra describes an accumulation ofpus in the uterine cavity.[19] In order for pyometra to develop, there must be both an infection and blockage of cervix. Signs and symptoms include lower abdominal pain (suprapubic), rigors, fever, and the discharge of pus on introduction of a sound into the uterus. Pyometra is treated with antibiotics, according toculture and sensitivity.[20]