What is endometritis?

Definition

Endometritis is an irritation or
inflammation of the endometrium, the inner lining of the uterus, that sometimes extends
into the myometrium and parametrial tissues. Pathologically, endometritis is
classified as acute or chronic. Acute endometritis is distinguished by the
presence of neutrophils in the endometrial glands and chronic
endometritis is characterized by variable numbers of plasma cells and
lymphocytes within the endometrial stroma.

Causes

Endometritis is a microbial infection that can be caused by normal
vaginal bacteria and by chlamydia, gonorrhea, chronic pelvic inflammatory
disease, or tuberculosis. In most cases, it is initiated by an ascending infection
from organisms found in the normal vaginal flora. Infection may be produced by
compromised abortions, complicated deliveries, miscarriages, medical exam
instrumentation, and retention of placental fragments.

Risk Factors

The risk for endometritis increases after miscarriage or childbirth,
particularly after a long labor or a cesarean section. Medical procedures that
involve entering the uterus through the cervix such as hysteroscopy
and placement of an intrauterine device increase the risk of developing
endometritis. After vaginal delivery, incidence is between 1 and 3 percent,
whereas for cesarean delivery, incidence ranges from 13 to 90 percent.

Symptoms

The most common symptoms associated with endometritis are lower abdominal pain,
fever, and increased vaginal discharge or bleeding. There may be yellow,
foul-smelling vaginal discharge. Discomfort with bowel movement and constipation
may also occur. Menstruation can be excessive after acute endometritis, but the
excessive bleeding can usually be resolved after two weeks of antibiotic
treatment. Patients suffering from chronic endometritis may have an underlying
cancer of the cervix or endometrium.

Screening and Diagnosis

Physical and pelvic exams will be performed by a health care provider. The
lower abdomen, uterus, and cervix may be tender. Cervical discharge and decreased
bowel sounds may be present. Cultures may be taken from the cervix to test for
microbial infectious agents. Other tests performed often include an
endometrial
biopsy, laparoscopy, white blood count, and
microscopic examination of any vaginal discharge.

Treatment and Therapy

Broad-spectrum antibiotics are used to treat and prevent complications of endometritis. Treatments sometimes involve plenty of rest and administering fluids through a vein. For complicated cases of endometritis, hospitalization may be necessary.

Prevention and Outcomes

The risk of endometritis can be reduced by employing careful, sterile techniques during the delivery of a baby, during an abortion, or during any gynecological procedures. Safer sex practices reduce the risk of endometritis caused by sexually transmitted infections.

Bibliography

Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2006.

Berek, Jonathan S., ed. Berek and Novak’s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

Dallenbach-Hellweg, Gisela, Dietmar Schmidt, and Friederike Dallenbach. Atlas of Endometrial Histopathology. 3d ed. New York: Springer, 2010.

Icon Health. Endometritis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2003.

Katz, V. I., et al., eds. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier, 2007.

Wilson, Walter, and Merle Sande. Current Diagnosis and Treatment in Infectious Diseases. New York: McGraw-Hill Medical, 2001.