Endometritis remains a serious problem in gynecology today. Despite the efforts of doctors to prevent inflammation of the inner lining of the uterus, this problem is relevant not only for women who have recently given birth. Often, women, having discovered suspicious discharge and noting malaise, self-medicate and delay contacting a doctor. This leads to the spread of inflammation also to the muscular layer of the uterus, complicating the course and therapy of the pathology. As a result, untimely treatment of endometritis, which has passed into a chronic form, is often no longer as effective as it would be in the acute stage, complications and infertility are possible, inflammation can move to organs adjacent to the genitals.
Causes of inflammation: the role of infection
In its course, endometritis can be acute or chronic. For acute inflammation, the most striking and pronounced symptoms are typical. The transition to the chronic form occurs against the background of self-treatment, with the wrong tactics for managing a woman, if the diagnosis is incorrectly made or there are problems with the immune system, hormonal metabolism. In chronic endometritis, inflammation is maintained by the constant presence of infection in the mucosal area, which threatens with irreversible tissue changes.
Inflammation is formed as a result of damage to the mucosa, whether it be mechanical, physical or biological stimuli. The penetration of infection into the uterine cavity is possible against the background of a decrease in immunity, inflammatory processes in the area of the external genitalia, vagina and cervix. A significant role is played by medical manipulations, leading to injury to the mucous membranes, the introduction of microbes and inflammation. If we talk about microbial infection, the main pathogens are opportunistic species of bacteria, chlamydia or mycoplasma. Less commonly, it may be other types of infection.
When is there a risk of endometritis?
Naturally, the basis of endometritis is the penetration of infection into the uterine cavity with involvement in the process of inflammation of the endometrium. Viral lesions, aseptic inflammation are possible, especially against the background of certain manipulations. Contribute to the development of endometritis abortions, including those of a criminal nature, without observing all the rules of asepsis. Endometritis can be formed by therapeutic or diagnostic curettage of the endometrium, the procedure for probing the uterine cavity, hysterosalpingography with tube blowing. It is possible to develop an inflammatory process during the installation of the intrauterine device due to the fact that it is a foreign body, as well as with a passion for such a procedure as douching. A special place in the structure of the pathology is occupied by postpartum endometritis, which occurs due to infection of an extensive wound surface, which is the uterus after childbirth.
Manifestations of endometritis: pain, discharge, fever
Not always manifestations can be pronounced and vivid, so it is important for a woman to pay attention to any changes in discharge, pain in the lower abdomen, and malaise. Especially closely you need to monitor the condition in the coming days after intrauterine interventions. Such manifestations as a sharp rise in temperature to 38-39 ℃ against the background of sweating and chills, bloody discharge from the genital tract, or purulent, mucous are dangerous. The presence of general weakness and malaise, pallor and pain in the lower abdomen, which radiates to the sacrum or pubis, is also typical. Especially closely it is necessary to evaluate the discharge and the general condition after childbirth or miscarriage, abortion. The presence of dangerous symptoms should be a reason for immediate hospitalization.
Manifestations of chronic endometritis are even more scarce, they include temperature fluctuations within 37-38 ℃, irregular uterine bleeding, the appearance of blood between menstruation. Dangerous discharge with an unpleasant odor and an admixture of mucus, greenery, yellow. Pain during bowel movements, intercourse or intermittent discomfort in the lower abdomen, problems conceiving, or frequent miscarriages may be suspicious for endometritis.
Diagnostic features: palpation of the uterus, ultrasound, tests
Any alarming symptoms that may indicate an inflammatory process are a reason to see a doctor. It is necessary to describe in detail all your complaints, discomfort in the uterus and genitals, the nature of the discharge, and also report if any procedures have recently been performed. The doctor examines the uterus on the chair — its shape and size are probed, pain is assessed, the presence of discharge from the cervix when viewed in the mirrors. To determine the inflammation of the inner lining of the uterus, smears from the cervical canal and vaginal walls with the definition of flora are needed. Blood tests are prescribed with the definition of inflammatory changes, as well as ultrasound of the genitals. During its implementation, the uterus and its cavity, inflammatory changes, accumulation of pus, damage to the tubes and ovaries are evaluated.
How is endometritis treated?
Usually, in an acute process, endometritis is treated in a hospital, a chronic process can be treated on an outpatient basis, but under constant medical supervision. In the acute phase, gradual relief of inflammation and restoration of the functionality of the organ are shown. In the treatment of endometritis, antibiotics are used based on the results of sowing in combination with metrogil to enhance the antibacterial effect. As the condition improves, the transition to oral forms of therapy is carried out.
If this is the postpartum period, there are remnants of the fetal egg and endometrium in the uterus, the treatment of endometritis involves scraping the cavity after antibiotic therapy and infusions. Symptomatic remedies, vitamins, immunomodulatory treatment are also shown. During the recovery period, the treatment of endometritis involves the use of physiotherapy.
Then a long period of rehabilitation is needed with active preventive measures to prevent the re-introduction of infection into the uterine cavity.
Prevention and treatment of endometritis after childbirth and caesarean section / Tyutyunnik V.L., Gurtovoy B.L. // breast — 2002 — T. 10 No. 18
Characteristics of microecological disorders in endometritis / Glukhova E.V., Cherkasov S.V., Sgibnev A.V., Bukharin O.V. // Journal of Microbiology, Epidemiology and Immunobiology — 2009 — #4