Endometritis is inflammation of the inner lining of the uterus (endometrium).
Endometritis is divided into acute and chronic forms.[ Risk factors for endometritis following delivery include Caesarean section and prolonged rupture of membranes.][ Chronic endometritis is more common after menopause.][ The diagnosis may be confirmed by endometrial biopsy.][
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Treatment is usually with .[ Recommendations for treatment of endometritis following delivery includes clindamycin with gentamicin.][ Chronic disease may be treated with doxycycline.][
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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.
Signs and symptoms
The primary clinical manifestations of endometritis include fever and uterine pain with tenderness upon palpation. When the physician moves the uterus during examination, patients typically experience increased discomfort. Post-delivery vaginal discharge (lochia) sometimes presents with an unpleasant smell, though this is not always observed. Fevers in affected patients commonly fall between 38°C and 40°C (100.4°F to 104°F), with most cases trending toward the lower end of this range. Symptom onset typically occurs 2-3 days following childbirth, although when fever appears within hours after delivery alongside Hypotension, it strongly suggests an infection with Beta-hemolysis Streptococcus.
More complicated and uncommon presentations may involve significant fever, general unwellness, sensitivity in the abdominal region, slowed intestinal activity, reduced blood pressure, and sepsis. It should also be noted that as many as 10% of uncomplicated postpartum endometritis cases will feature clinically insignificant bacteremia. Thus, positive blood cultures do not necessarily indicate systemic infection.
The abdominal discomfort is typically concentrated in the lower middle abdomen. Blood tests commonly reveal an elevated white blood cell count, though it's important to note that such elevations can occur normally during labor and the early postpartum period without indicating infection.[Poggi S.H. (2019). Postpartum hemorrhage & the abnormal puerperium. DeCherney A.H., & Nathan L, & Laufer N, & Roman A.S.(Eds.), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12e. McGraw-Hill Education.]
Types
Acute endometritis
There is very uncertain evidence supporting the use of prophylactic antibiotics to prevent endometritis after manual removal of the placenta in vaginal birth.
In certain populations, it has been associated with Mycoplasma genitalium and pelvic inflammatory disease.
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 an infectious cause is more common). Antibiotic therapy is curative in most cases (depending on the 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.
Chronic granulomatous endometritis is usually caused by tuberculosis. The granulomas are small, sparse, and without Caseous necrosis. 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 complains of lower abdominal pain.
Pyometra
Pyometra describes an accumulation of pus in the uterine cavity.
See also
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