Endometritis

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Endometritis
Other namesPostpartum endometritis, endomyometritis
Endometritis - 2 - cropped - very high mag.jpg
Micrograph showing a chronic endometritis with the characteristic plasma cells. Scattered neutrophils are also present. H&E stain.
Specialty Gynaecology, obstetrics
Symptoms Fever, lower abdominal pain, abnormal vaginal bleeding, discharge [1]
TypesAcute, chronic [2]
Causes Infectious [2]
Risk factors Abortion, menstruation, childbirth, placement of an IUD, douching [3] [2]
Treatment Antibiotics [1]
Prognosis Good with treatment [4]
Frequency2% (following vaginal delivery),
10% (following scheduled C-section) [5]

Endometritis is inflammation of the inner lining of the uterus (endometrium). [6] Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. [1] [4] It is the most common cause of infection after childbirth. [7] [1] It is also part of spectrum of diseases that make up pelvic inflammatory disease. [8]

Contents

Endometritis is divided into acute and chronic forms. [2] The acute form is usually from an infection that passes through the cervix as a result of an abortion, during menstruation, following childbirth, or as a result of douching or placement of an IUD. [2] [3] Risk factors for endometritis following delivery include Caesarean section and prolonged rupture of membranes. [1] Chronic endometritis is more common after menopause. [2] The diagnosis may be confirmed by endometrial biopsy. [3] Ultrasound may be useful to verify that there is no retained tissue within the uterus. [4]

Treatment is usually with antibiotics. [1] Recommendations for treatment of endometritis following delivery includes clindamycin with gentamicin. [9] Testing for and treating gonorrhea and chlamydia in those at risk is also recommended. [10] Chronic disease may be treated with doxycycline. [10] Outcomes with treatment are generally good. [4]

Rates of endometritis are about 2% following vaginal 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 the myometrium is present. [11] The condition is also relatively common in other animals such as cows. [12]

Symptoms

Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge. [1] [4]

Types

Acute endometritis

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 not enough evidence for 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 of clindamycin and gentamicin IV antibiotic treatment.

In certain populations, it has been associated with Mycoplasma genitalium and pelvic inflammatory disease. [15] [16]

Chronic endometritis

Chronic endometritis is characterized by the presence of plasma 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 are Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Streptococcus agalactiae (Group B Streptococcus), Mycoplasma hominis, tuberculosis, and various viruses. Most of these agents are capable of causing chronic pelvic 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 without caseation. 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

Pyometra describes an accumulation of pus 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 to culture and sensitivity. [20]

See also

Related Research Articles

<span class="mw-page-title-main">Chlamydia</span> Sexually transmitted infection caused by the bacterium Chlamydia trachomatis

Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Most people who are infected have no symptoms. When symptoms do appear they may occur only several weeks after infection; the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. Symptoms in women may include vaginal discharge or burning with urination. Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Cervicitis</span> Inflammation of the uterine cervix

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.

<span class="mw-page-title-main">Pyometra</span> Medical condition

Pyometra or pyometritis is a uterine infection. Though it is most commonly known as a disease of the unaltered female dog, it is also a notable human disease. It is also seen in female cattle, horses, goats, sheep, swine, cats, rabbits, hamsters, ferrets, rats and guinea pigs. Pyometra is an important disease to be aware of for any dog or cat owner because of the sudden nature of the disease and the deadly consequences if left untreated. It has been compared to acute appendicitis in humans, because both are essentially empyemas within an abdominal organ.

<span class="mw-page-title-main">Postpartum infections</span> Human disease

Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge. It usually occurs after the first 24 hours and within the first ten days following delivery.

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

<span class="mw-page-title-main">Salpingitis</span> Medical condition

Salpingitis is an infection causing inflammation in the fallopian tubes. It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, and peritonitis.

Intermenstrual bleeding (IMB) is vaginal bleeding at irregular intervals between expected menstrual periods. It may be associated with bleeding with sexual intercourse.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Chorioamnionitis</span> Medical condition

Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes, usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert panel recommended use of the term "triple I" to address the heterogeneity of this disorder. The term triple I refers to intrauterine infection or inflammation or both and is defined by strict diagnostic criteria, but this terminology has not been commonly adopted although the criteria are used.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Septic abortion describes any type of abortion, due to an upper genital tract bacterial infection including the inflammation of the endometrium during or after 20 weeks of gestation. The genital tract during this period is particularly vulnerable to infection, and sepsis in most cases is caused by a combination of factors both due to facility conditions and/or individual predispositions. The infection often starts in the placenta and fetus, with a potential complication of also affecting the uterus, that can result in sepsis spreading to surrounding organs, or pelvic infections.

Septic pelvic thrombophlebitis (SPT), also known as suppurative pelvic thrombophlebitis, is a rare postpartum complication which consists of a persistent postpartum fever that is not responsive to broad-spectrum antibiotics, in which pelvic infection leads to infection of the vein wall and intimal damage leading to thrombogenesis in the ovarian veins. The thrombus is then invaded by microorganisms. Ascending infections cause 99% of postpartum SPT.

<span class="mw-page-title-main">Tubal factor infertility</span> Medical condition

Tubal factor infertility (TFI) is female infertility caused by diseases, obstructions, damage, scarring, congenital malformations or other factors which impede the descent of a fertilized or unfertilized ovum into the uterus through the Fallopian tubes and prevents a normal pregnancy and full term birth. Tubal factors cause 25-30% of infertility cases. Tubal factor is one complication of Chlamydia trachomatis infection in women.

<span class="mw-page-title-main">Tubo-ovarian abscess</span> One of the late complications of pelvic inflammatory disease

A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary. These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. It is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs. A TOA can also develop as a complication of a hysterectomy.

The exact role of Mycoplasma hominis in regards to a number of conditions related to pregnant women and their (unborn) offspring is controversial. This is mainly because many healthy adults have genitourinary colonization with Mycoplasma, published studies on pathogenicity have important design limitations and the organisms are very difficult to detect. The likelihood of colonization with M. hominis appears directly linked to the number of lifetime sexual partners Neonatal colonization does occur, but only through normal vaginal delivery. Caesarean section appears protective against colonization and is much less common. Neonatal colonization is transient.

Pelvic abscess is a collection of pus in the pelvis, typically occurring following lower abdominal surgical procedures, or as a complication of pelvic inflammatory disease (PID), appendicitis, or lower genital tract infections. Signs and symptoms include a high fever, pelvic mass, vaginal bleeding or discharge, and lower abdominal pain. It can lead to sepsis and death.

References

  1. 1 2 3 4 5 6 7 "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290. ISBN   9781455775583.
  2. 1 2 3 4 5 6 Dallenbach-Hellweg, Gisela; Schmidt, Dietmar; Dallenbach, Friederike (2010). Atlas of Endometrial Histopathology. Springer Science & Business Media. p. 135. ISBN   9783642015410.
  3. 1 2 3 Lobo, Rogerio A.; Gershenson, David M.; Lentz, Gretchen M.; Valea, Fidel A. (2016). Comprehensive Gynecology E-Book. Elsevier Health Sciences. p. 548. ISBN   9780323430036.
  4. 1 2 3 4 5 Ferri, Fred F. (2014). Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 423. ISBN   9780323084307.
  5. 1 2 Gabbe, Steven G. (2012). Obstetrics: Normal and Problem Pregnancies. Elsevier Health Sciences. p. 1146. ISBN   978-1437719352.
  6. ↑ Crum, Christopher P.; Lee, Kenneth R.; Nucci, Marisa R. (2011). Diagnostic Gynecologic and Obstetric Pathology E-Book. Elsevier Health Sciences. p. 430. ISBN   978-1455708956.
  7. ↑ Arora, Mala; Walavalkar, Rajalaxmi (2013). World Clinics: Obstetrics & Gynecology: Postpartum Hemorrhage. JP Medical Ltd. p. 237. ISBN   9789350904244.
  8. ↑ "Sexually Transmitted Diseases & Pelvic Infections". Current diagnosis & treatment : obstetrics & gynecology (11 ed.). McGraw-Hill Education. 2012. p. Chapter 43. ISBN   978-0071638562.
  9. ↑ Mackeen, AD; Packard, RE; Ota, E; Speer, L (2 February 2015). "Antibiotic regimens for postpartum endometritis". The Cochrane Database of Systematic Reviews. 2015 (2): CD001067. doi:10.1002/14651858.CD001067.pub3. PMC   7050613 . PMID   25922861.
  10. 1 2 "8". Williams Gynecology (3 ed.). McGraw Hill Professional. 2016. ISBN   9780071849081.
  11. ↑ Hubert Guedj; Baggish, Michael S.; Valle, Rafael Heliodoro (2007). Hysteroscopy: visual perspectives of uterine anatomy, physiology, and pathology. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 488. ISBN   978-0-7817-5532-0.
  12. ↑ Noakes, David E. (2009). Arthur's Veterinary Reproduction and Obstetrics E-Book. Elsevier Health Sciences. p. 411. ISBN   9780702039904.
  13. ↑ "Endometritis - Pregnancy Articles". pregmed.org. 21 November 2013. Retrieved 11 April 2018.
  14. ↑ Chongsomchai, C; Lumbiganon, P; Laopaiboon, M (Oct 20, 2014). "Prophylactic antibiotics for manual removal of retained placenta in vaginal birth". The Cochrane Database of Systematic Reviews. 10 (10): CD004904. doi:10.1002/14651858.CD004904.pub3. PMC   7390442 . PMID   25327508.
  15. ↑ Cohen CR, Manhart LE, Bukusi EA, et al. (March 2002). "Association between Mycoplasma genitalium and acute endometritis". Lancet. 359 (9308): 765–6. doi:10.1016/S0140-6736(02)07848-0. PMID   11888591. S2CID   36191700.
  16. ↑ Ljubin-Sternak, Suncanica; Mestrovic, Tomislav (2014). "Review: Chlamydia trachonmatis and Genital Mycoplasmias: Pathogens with an Impact on Human Reproductive Health". Journal of Pathogens. 2014 (183167): 3. doi: 10.1155/2014/183167 . PMC   4295611 . PMID   25614838.
  17. ↑ Buzzaccarini G, Vitagliano A, Andrisani A, Santarsiero CM, Cicinelli R, Nardelli C, Ambrosini G, Cicinelli E (December 2020). "Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review". Journal of Assisted Reproduction and Genetics. 37 (12): 2897–2911. doi: 10.1007/s10815-020-01955-8 . PMC   7714873 . PMID   33025403.
  18. ↑ Rimmer MP, Fishwick K, Henderson I, Chinn D, Al Wattar BH, Quenby S (December 2020). "Quantifying CD138+ cells in the endometrium to assess chronic endometritis in women at risk of recurrent pregnancy loss: A prospective cohort study and rapid review" (PDF). The Journal of Obstetrics and Gynaecology Research. 47 (2): 689–697. doi:10.1111/jog.14585. PMID   33274569. S2CID   227283325.
  19. ↑ "Pyometra". American College of Veterinary Surgeons. 2004. Archived from the original on 2006-02-21. Retrieved 2006-12-14.
  20. ↑ Höglund, Odd Viking; Lövebrant, Johanna; Olsson, Ulf; Höglund, Katja (17 November 2016). "Blood pressure and heart rate during ovariohysterectomy in pyometra and control dogs: a preliminary investigation". Acta Veterinaria Scandinavica. 58 (1): 80. doi: 10.1186/s13028-016-0263-y . PMC   5112883 . PMID   27855712.
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