Endometritis is an inflammatory process in the inner mucous layer of the uterus - endometrium. It is often combined with inflammation of the muscular layer of the uterus - endomyometritis. Endometrium is an internal functional membrane of the uterus, which changes its structure during the menstrual cycle. Each cycle, it grows and ripens anew, preparing to attach a fertilized egg, and is rejected if the pregnancy does not occur. Normally, the uterine cavity lined with the endometrium is reliably protected from infection. But under certain conditions, infectious pathogens easily enter the uterus and cause an inflammatory reaction of its inner layer - endometritis. By the nature of the flow, the acute and chronic form of the endometritis is isolated.
The onset of acute endometritis is often preceded by childbirth, abortion or a mini-abortion, diagnostic curettage of the uterine cavity, hysteroscopy and other intra-uterine manipulation. Incomplete removal of the remains of the fetal egg, the placenta, the accumulation of liquid blood and clots favor the development of infection and acute inflammation of the inner surface of the uterus. The most common manifestation of postpartum infection is postpartum endometritis. It occurs in 4% -20% of cases after natural delivery and in 40% after cesarean section. This is due to hormonal and immune rearrangement in the body of a pregnant woman, a decrease in overall immunity and resistance to infections.
Endometritis can be caused by various pathogens: bacteria, viruses, fungi, parasites, mixed flora. Depending on the nature of the origin, specific endometritis and nonspecific are distinguished. To specific include infectious (viral, chlamydial, bacterial, protozoal, fungal) and parasitic endometritis. They can cause such pathogens as herpes simplex viruses, cytomegalovirus, chlamydia, mycobacterium tuberculosis, toxoplasma, mycoplasmas, candida, radiant fungi, gonococci, etc. In the development of endometritis, the state of the immune, endocrine, and nervous systems is important, often aggravating the course of the disease. With the nonspecific nature of endometritis, the pathogenic flora in the uterus is not detected. The nonspecific form of endometritis can be caused by bacterial vaginosis, HIV infection, the presence of an intrauterine device, the use of hormonal contraceptives.
The chronic form of endometritis is often a consequence of an untreated acute endometritis that has arisen after childbirth, abortion, intrauterine manipulation, due to the presence of foreign bodies of the uterus. In 80-90% of cases, chronic endometritis occurs among women of the reproductive period and tends to increase, which is explained by the widespread prevalence of intrauterine contraception, the increase in the number of abortions, intrauterine diagnostic and treatment procedures. Chronic endometritis is one of the most common causes of infertility, miscarriages, failed attempts at in vitro fertilization, complicated pregnancies, childbirth and the postpartum period.
To detect an infectious agent in chronic endometritis, high-precision immunocytochemical diagnosis is used. The chronic form of endometritis often has an erased clinical course without pronounced signs of microbial infection. There is a thickening of the mucous uterus, serous coating, hemorrhages, fibrous adhesions leading to a disruption of the normal functioning of the endometrium.
Symptoms of acute endometritis
Acute endometritis usually develops 3-4 days after infection and is manifested by fever, abdominal pain, discharge from the genital tract with an unpleasant odor, painful urination, increased heart rate, chills. Especially severe and rapid flow have acute endometritis in patients with intrauterine spirals. Therefore, the first signs of acute endometritis are the reason for an immediate consultation with a gynecologist.
With a gynecological examination, a moderately enlarged and painful uterus, prenatal or serous-purulent discharge is determined. The acute stage lasts from a week to ten days and, with effective therapy, ends with a cure, otherwise a transition to chronic endometritis.
Symptoms of chronic endometritis
The severity of the course of chronic endometritis is due to the depth and duration of the existence of structural changes in the endometrium. The main manifestations of chronic endometritis are disorders of the menstrual cycle (sparse or profuse menstrual periods), uterine bleeding, pathological serous-purulent or spotting, aching pain in the lower abdomen, painful sexual intercourse. With a two-handed gynecological examination, a slight compaction and an increase in the uterus in size is revealed. Structural changes in the endometrium in chronic endometrium can cause the formation and proliferation of polyps and cysts. Chronic endometritis in 10% of cases is the cause of infertility, in 60% - miscarriage. In the inflammatory process is often involved and the muscular layer of the uterus - there is myoendometritis.
Risk of endometritis
In the emergence of endometritis, a special role is played by the reduction of barrier defense mechanisms that prevent the penetration of infection into the internal sexual organs. This can be caused by the following reasons: Maternal injuries.
The ruptures of the perineum, vagina, cervix in labor contribute to the penetration of infection in the genital tract and its ascent into the uterine cavity.
Mechanical, chemical, thermal factors, damaging the mucous membrane of the vagina Violation of genital hygiene, frequent douching, use of vaginal spermicides, etc., lead to a change in the normal microflora of the vagina and its protective properties. Menstruation, childbirth, abortion
The secretion of blood leads to the washing out of the secretion of the cervical canal, alkalizing the acidic environment of the vagina and reducing its bactericidal properties. In these conditions, pathogenic microorganisms freely penetrate from the external environment and actively multiply on the wound surface of the uterus.
For a long time, intrauterine spirals located in the uterine cavity become a potential source of inflammation, which promotes penetration of the infection by the ascending pathway through the IUD strands. If there was an endometrium, then you need to remove the IUD. Using vaginal tampons.
Absorbing bloody discharge, tampons are the optimal medium for the development of infection. Tampons should be changed every 4-6 hours, do not use them at night, before or after menstruation, in hot climates. Violation of the rules for the use of tampons can lead to the development of toxic shock syndrome. Chronic stress, overwork and lack of hygiene.
These factors weaken the body and make it vulnerable to infection.
Diagnosis of endometritis
Diagnosis of acute endometritis is based on the collection of anamnesis of the disease, patient complaints, symptoms, gynecological examination, a clinical blood test and a bacterioscopic examination of smears. Women with acute form of endometritis are treated permanently, because there is a potential danger of developing severe septic complications (parametritis, pelvic peritonitis, peritonitis). When diagnosing the chronic form of endometritis, in addition to clarifying the clinical symptoms and anamnesis of the disease, a special role belongs to the scraping of the uterus's mucosa. A histological study of the altered endometrium confirms the diagnosis of chronic endometritis. Important diagnostic methods are ultrasonic (ultrasound) and endoscopic (hysteroscopy) studies, which reveal structural changes in the endometrium.
Treatment of acute endometritis
In acute phase of endometritis patients are shown treatment in a hospital with observance of bed rest, mental and physical rest, easily assimilated high-grade diet, drinking regimen. The basis of drug treatment of acute endometritis is antibacterial therapy taking into account the sensitivity of the pathogen (amoxicillin, ampicillin, clindamycin, gentamicin, kanamycin, lincomycin, etc.). With a mixed microbial flora, a combination of several antibiotics is shown. In view of the frequent addition of anaerobic pathogens, metronidazole is included in the treatment of acute endometritis. With the aim of removing intoxication intravenous injection of saline and protein solutions is shown up to 2-2.5 liters per day. It is advisable to include in the treatment of acute endometritis multivitamins, antihistamines, immunomodulators, probiotics, antifungal agents. With a painkiller, anti-inflammatory and gemostatic purpose, cold is applied to the abdominal region (2 hours - cold, 30 minutes - break). When the acute symptoms subsided, physiotherapy, hirudotherapy (medical leeches) are prescribed.
Treatment of chronic endometritis
In the treatment of chronic endometritis, modern gynecology uses a comprehensive approach, including antimicrobial, immunomodulating, restorative, physiotherapeutic treatment. Treatment is carried out in stages. The first step is to eliminate infectious agents, followed by a course aimed at restoring the endometrium. Usually, antibiotics of a wide spectrum of action (sparfloxacin, doxycycline, etc.) are used. The restoration course is based on a combination of hormonal (estradiol plus progesterone) and metabolic therapy (blood calves calves, inosine, ascorbic acid, vitamin E).
Medicinal preparations can be injected directly into the uterine mucosa, which creates their increased concentration directly in the inflammatory focus and provides a high therapeutic effect. Coping uterine bleeding is performed by the appointment of hormones or aminocaproic acid solution (intravenously or intrauterine). Important role in the treatment of chronic endometritis is given to physiotherapy: UHF, electrophoresis of copper, zinc, lidase, iodine, pulse ultrasound therapy, magnetotherapy. Physiotherapeutic treatment reduces inflammatory edema of the endometrium, activates blood circulation, stimulates immunological reactions. Patients with chronic endometritis are shown balneotherapy (mud cure, hydrotherapy).
The effectiveness of treatment of chronic endometritis is assessed by the following criteria:
- Restoration of the morphological structure of the endometrium (by ultrasound results)
- Restoration of the menstrual cycle
- Elimination of infection
- The disappearance of pathological symptoms (pain, bleeding)
- Restoration of genital function