Endometritis

Not to be confused with Endometriosis.
Endometritis
Other namesPostpartum endometritis, endomyometritis
Micrograph showing a chronic endometritis with the characteristic plasma cells. Scattered neutrophils are also present. H&E stain.
SpecialtyGynaecology, obstetrics
SymptomsFever, lower abdominal pain, abnormal vaginal bleeding, discharge[1]
TypesAcute, chronic[2]
CausesInfectious[2]
Risk factorsAbortion, menstruation, childbirth, placement of an IUD, douching[3][2]
TreatmentAntibiotics[1]
PrognosisGood with treatment[4]
Frequency2% (following vaginal delivery),
10% (following scheduled C-section)[5]

Endometritis is inflammation of the inner lining of the uterus (endometrium).[6] Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or discharge.[1][4] It is the most common cause of infection after childbirth.[7][1] It is also part of spectrum of diseases that make up pelvic inflammatory disease.[8]

Endometritis is divided into acute and chronic forms.[2] The acute form is usually from an infection that passes through the cervix as a result of an abortion, during menstruation, following childbirth, or as a result of douching or placement of an IUD.[2][3] Risk factors for endometritis following delivery include Caesarean section and prolonged rupture of membranes.[1] Chronic endometritis is more common after menopause.[2] The diagnosis may be confirmed by endometrial biopsy.[3] Ultrasound may be useful to verify that there is no retained tissue within the uterus.[4]

Treatment is usually with antibiotics.[1] Recommendations for treatment of endometritis following delivery includes clindamycin with gentamicin.[9] Testing for and treating gonorrhea and chlamydia in those at risk is also recommended.[10] Chronic disease may be treated with doxycycline.[10] Outcomes with treatment are generally good.[4]

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.[5] The term "endomyometritis" may be used when inflammation of the endometrium and the myometrium is present.[11] The condition is also relatively common in other animals such as cows.[12]

  1. ^ a b c d e f "Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology". Hacker & Moore's essentials of obstetrics and gynecology (6 ed.). Elsevier Canada. 2015. pp. 276–290. ISBN 9781455775583.
  2. ^ a b c d e f Dallenbach-Hellweg, Gisela; Schmidt, Dietmar; Dallenbach, Friederike (2010). Atlas of Endometrial Histopathology. Springer Science & Business Media. p. 135. ISBN 9783642015410.
  3. ^ a b c Lobo, Rogerio A.; Gershenson, David M.; Lentz, Gretchen M.; Valea, Fidel A. (2016). Comprehensive Gynecology E-Book. Elsevier Health Sciences. p. 548. ISBN 9780323430036.
  4. ^ a b c d Ferri, Fred F. (2014). Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 423. ISBN 9780323084307.
  5. ^ a b Gabbe, Steven G. (2012). Obstetrics: Normal and Problem Pregnancies. Elsevier Health Sciences. p. 1146. ISBN 978-1437719352.
  6. ^ Crum, Christopher P.; Lee, Kenneth R.; Nucci, Marisa R. (2011). Diagnostic Gynecologic and Obstetric Pathology E-Book. Elsevier Health Sciences. p. 430. ISBN 978-1455708956.
  7. ^ Arora, Mala; Walavalkar, Rajalaxmi (2013). World Clinics: Obstetrics & Gynecology: Postpartum Hemorrhage. JP Medical Ltd. p. 237. ISBN 9789350904244.
  8. ^ "Sexually Transmitted Diseases & Pelvic Infections". Current diagnosis & treatment : obstetrics & gynecology (11 ed.). McGraw-Hill Education. 2012. p. Chapter 43. ISBN 978-0071638562.
  9. ^ Mackeen, AD; Packard, RE; Ota, E; Speer, L (2 February 2015). "Antibiotic regimens for postpartum endometritis". The Cochrane Database of Systematic Reviews. 2015 (2): CD001067. doi:10.1002/14651858.CD001067.pub3. PMC 7050613. PMID 25922861.
  10. ^ a b "8". Williams Gynecology (3 ed.). McGraw Hill Professional. 2016. ISBN 9780071849081.
  11. ^ Hubert Guedj; Baggish, Michael S.; Valle, Rafael Heliodoro (2007). Hysteroscopy: visual perspectives of uterine anatomy, physiology, and pathology. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 488. ISBN 978-0-7817-5532-0.
  12. ^ Noakes, David E. (2009). Arthur's Veterinary Reproduction and Obstetrics E-Book. Elsevier Health Sciences. p. 411. ISBN 9780702039904.