What Is Endometritis?

Endometritis is an inflammatory change in the structure of the endometrium caused by various reasons. Bacteria can reach the endometrium along the vagina, cervix or down the fallopian tubes and through the lymphatic system. Usually the uterine cavity has good drainage conditions and periodic endometrial exfoliation, so that there is very little chance for inflammation to stay in the endometrium for a long time. However, if the inflammation in the acute phase is not completely treated or the source of infection is often present, the inflammation can be recurrent and serious. Can affect the myometrium and become uterine myositis. Endometritis can be divided into acute endometritis and chronic endometritis. Chronic endometritis often coexists with chronic cervicitis and chronic salpingitis, and is the most common cause of abortion.

Basic Information

English name: endometritis
Visiting department: Obstetrics and Gynecology

Common causes: Caused by intrauterine lesions, cervicitis, vaginitis, etc.
Common symptoms: Fever, pain in the pelvic region, excessive leucorrhea, excessive menstruation, dysmenorrhea, etc.
Contagious: no

Causes of endometritis

Pregnancy and childbirth

Infant puerperal infection and infectious abortion are common causes of acute endometritis. A small amount of placenta or placenta remains in the uterine cavity after childbirth, or the uterine insufficiency of the placenta attachment site can cause chronic endometritis.

2. Intrauterine Surgery and IUD Placement

Intrauterine surgery, especially irregular abortion, can cause bacterial invasion and infection. Long-term stimulation of the IUD can cause chronic endometritis.

3. Not paying attention to personal hygiene

Menstrual intercourse and heterosexual intercourse with a sexually transmitted disease are also prone to this disease.

4. Intrauterine lesions

Endometrial polyps, submucosal fibroids, or endometrial cancer necrosis can cause endometrial infections.

5. Other gynecological inflammation

Ascending infections of cervicitis and vaginitis; descending spread of fallopian tube ovarian inflammation can cause endometritis.

6. Low estrogen levels

After menopause or menopause, the level of estrogen in the body decreases, the acidity in the vagina decreases, and the cervical mucus plugs decrease, the physiological barrier function of the human body weakens, and bacteria easily invade.

Clinical manifestations of endometritis

(A) chronic endometritis

Symptoms

(1) Pain in the pelvic area Pain in the lower abdomen and lumbosacral pain during menstrual breaks. Some patients may not have any conscious symptoms.

(2) Increased leucorrhea due to increased secretion of endometrial glands. Generally thin water samples, pale yellow, sometimes bloody leucorrhea. Senile endometritis is a purulent leucorrhea and often contains a small amount of blood. When the uterus is purulent, the discharge is purulent with an odor.

(3) The menstrual period multiplies the menstrual blood volume and the bleeding period is significantly prolonged. Irregular bleeding is rare.

(4) Dysmenorrhea is more common in unborn women, but severe dysmenorrhea is rare. It may be caused by excessive thickening of the endometrium, preventing normal metamorphosis and necrosis of the tissue, and stimulating excessive spasmodic contraction of the uterus.

2. Signs

The uterus can be enlarged with tenderness; the tissue near the uterus is thickened and tender. In mild inflammation, the double consultation can be found abnormally. When the uterus accumulates, the uterus is enlarged, tender, and tender. The speculum examination shows that the pus is draining bloody pus, and it smells strange.

(Two) acute endometritis

Symptoms

Mild fever, lower abdominal pain, increased leucorrhea, and sometimes bloody, if it is an anaerobic infection can have a foul odor. Acute endometrial inflammation that occurs after childbirth or miscarriage is more severe, and endometritis caused by other causes is mostly mild.

2. Signs

The uterus may have mild tenderness during the examination. If the condition is not controlled in time, it further causes uterine myositis, acute salpingitis, pelvic inflammatory disease, etc. The patient's body temperature rises significantly, up to 39 ° C, and the lower abdomen has obvious tenderness.

Endometritis examination

Vaginal examination

Should try to take the uterine cavity drainage to send bacteria culture and drug sensitivity test, smear for bacteria, for reference of action drugs. Examination of the speculum revealed a large amount of purulent or filthy bloody odorous discharge from the uterine mouth. Cervical pain during double consultation. The uterine body swells due to congestion and edema, is soft, and has tenderness.

2. Blood tests for inflammatory response indicators

Total white blood cells and neutrophil counts increased, and inflammatory indicators such as C-reactive protein and erythrocyte sedimentation increased.

3. Diagnostic curettage

Can identify the cause and exclude malignant lesions. Inflammation should be controlled for 3 days before surgery, and antibiotics should be continued after surgery. Intraoperative operation should be gentle, because the infected uterine wall is fragile, and it is easy to cause uterine perforation. Senile endometritis has a thin endometrium, which should be paid more attention when scraping. Endometritis may have residual embryonic tissue after abortion, which should be carefully and thoroughly scraped, which can often play a therapeutic role at the same time.

4. Pathological examination

Can identify the cause. There are a large number of infiltration of plasma cells and lymphocytes in the intimal stroma. Fibroblasts and capillary proliferation can be seen in those with longer inflammation.

Endometritis complications

Empyema

When endometritis causes cervical adhesion blockage, the inflammatory secretions in the uterine cavity cannot flow out and accumulate in the uterine cavity, which can form a pus in the uterine cavity.

Pelvic inflammatory disease

If the treatment of acute endometritis is not timely, it can further develop into fallopian tube ovitis, pelvic peritonitis, pelvic connective tissue inflammation, pelvic phlebitis, etc., and even develop into sepsis.

3. Infertility

Inflammable endometrium is not conducive to fertilized egg implantation, or fertilized egg implantation is not stable, leading to infertility. Endometritis also affects the fetus, which can cause malformations, miscarriages, preterm births, premature rupture of membranes, and neonatal infections.

Endometritis treatment

General processing

(1) It can supplement nutrition and water intravenously, and pay attention to correct electrolyte disorders and acidosis;

(2) Acute endometritis should rest in bed and should be in a semi-recumbent position to facilitate the limitation of inflammation and drainage of uterine secretions;

(3) Apply a hot compress to the lower abdomen to promote the absorption of inflammation and relieve pain;

(4) Keep the stool open to reduce pelvic congestion and facilitate toxin excretion;

(5) Physical cooling in high heat;

(6) Excessive gynecological examinations should be avoided to prevent the spread of inflammation.

2. Drug treatment

(1) Antibiotic treatment The main treatment is antibiotic treatment. The principles of antibiotic treatment are empirical, broad-spectrum, timely, and individualized. The selection of antibiotics should cover all possible pathogens, or antibiotic treatment should be selected according to the results of pathogen culture and drug sensitivity.

(2) Intrauterine administration For married patients, intrauterine administration can be used. Before operation, double-diagnosis should be performed to check the size and location of the uterus. The vulva and vagina are disinfected and the depth of the uterine cavity is detected. The urinary tube is sent into the uterine cavity from the uterine opening, and the depth of the uterine cavity can be 0.5 cm. The selected drug is slowly injected into the uterine cavity through the urinary catheter. After the drug solution has entered the uterine cavity, the urinary catheter is pulled out. Lying in the supine or gluteal position for 1 to 2 hours, once a day, stop during menstruation. Because this method can make the drug directly affect the lesion, the effect is often significant.

(3) Clean the uterine cavity . Endometritis that occurs after childbirth or abortion. If there is suspected placental tissue residue, it should be removed immediately when using antibiotics. When the antibiotics reach a certain dose and inflammation is controlled, curettage is feasible. Surgery to prevent the spread of inflammation. If there is active bleeding in the uterus, the uterine cavity can be cleared with a large amount of antibiotics.