Endometritis

Definition

Endometritis is an inflammation and/or irritation of the endometrium (lining of the uterus). (See also pelvic inflammatory disease.)

Causes, incidence, and risk factors

The usual cause of endometritis is infection. This includes chlamydial or gonococcal endometritis, frequently occurring among patients with salpingitis; tuberculous endometritis; purulent endometritis; and endometritis following surgery or other gynecological procedures that require insertion of medical instruments.

Endometritis may also occur following childbirth; abortion (therapeutic, elective, or spontaneous -- all of which can lead to septic abortion), or intrauterine device (IUD) insertion. Other risk factors may include a history of acute salpingitis, acute cervicitis, and other pelvic infections, including many of the sexually transmitted diseases.

Symptoms

• General discomfort, uneasiness, or ill feeling (malaise)
• A fever, which may range from low grade (100 to 102 degrees Fahrenheit) to high grade (103 to 104 degrees Fahrenheit)
• Lower abdominal or pelvic pain (uterine pain)
• Abnormal vaginal bleeding
• Abnormal vaginal discharge
  • Increased amount
  • Unusual color, consistency, or odor
• Discomfort with bowel movement (constipation may occur)
• Abdominal distention

Signs and tests

Palpation of the lower abdomen may show abdominal tenderness. Bowel sounds may be decreased. Upon pelvic examination, the uterus is tender, and there may be tenderness with manipulation of the cervix. A cervical discharge may be noted.

During diagnosis of endometritis, the tests performed include:

• A WBC (white blood count) -- elevated
• An ESR (sed rate) -- elevated
• Endocervical cultures for Chlamydia, gonorrhea, and other organisms
• An endometrial biopsy
• A laparoscopy

Treatment

More complicated cases (those occurring after childbirth, or those involving more widespread or well-established infection) may require hospitalization. Intravenous antibiotics are used and usually followed with a course of oral antibiotics.

Rest and hydration are important. The simultaneous treatment of sexual partner(s), when appropriate, and the use of condoms throughout the course of treatment, are essential.

Expectations (prognosis)

Most cases of endometritis resolve with adequate antibiotic therapy. Untreated endometritis can progress to more serious infection and result in complications with pelvic organs, reproduction, and general health.

Complications

• Pelvic peritonitis (generalized pelvic infection)
• Pelvic or uterine abscess formation
• Septicemia
• Septic shock
• Infertility

Calling your health care provider

Call for an appointment with your health care provider if symptoms of endometritis occur (particularly if within several days after childbirth, abortion, or IUD insertion).

Prevention

• "Safer" sexual practices
• Adequate patient compliance and provider follow-up after gynecological procedures
• Early diagnosis and adequate treatment (for partners also) of sexually transmitted diseases

The risk is reduced by the careful, sterile techniques utilized by appropriate providers in performing deliveries, abortions, IUD insertions, and other gynecological procedures.

Illustrations

Pelvic laparoscopy

Endometritis

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