Endometritis, metroendometritis - Causes, symptoms and treatment. MF.

Endometritis is an inflammatory disease of the uterine mucosa. Inflammation of the mucous membrane of the uterus can not but affect its muscle layer. In this case, the metroendometritis is diagnosed, which is much more likely to be found on the first page in the diagnosis and from the prognostic point of view is much worse for the patient. In order to understand the differences and similarities of these diagnoses, it is necessary to touch the structure of the uterus a little.

Uterus consists of: cervix, uterus body and fallopian tubes. In the subject we are discussing, it is most important to consider the structure of the uterus body. It consists of the endometrium( the mucous membrane of the uterus - namely, its rejection and is accompanied by bleeding at monthly, the same is implanted in the fetal egg), myometrium( its muscular membrane that stretches during pregnancy, allowing the organ to grow many tens of times) and perimetry( external, Serous membrane - is a continuation of the peritoneal sheets from the bladder).Despite the fact that the endometrium and myometrium can be demarcated both visually and histologically, the connection between them is very very close, which leads to the fact that pathological processes in one almost immediately capture another layer.

The endometrium consists of two fundamentally different layers: functional - one that exfoliates at the end of each monthly and basal layer, which causes the formation of a new functional layer, and, consequently, causes the onset of the following menstrual periods. The functional layer is represented by one layer of cells resembling cylinders( cylindrical epithelium), between which are located glandular cells( produce the necessary mucus) and the terminal branches of small spiral arteries, in the set here located. Such a structure, single-layered cells and the presence of a large number of small vessels, is quite fragile and susceptible to adverse effects.

It is the damage to the above structures and leads to the possibility of infection and the occurrence of an inflammatory process - endometritis. However, as mentioned above, the close connection of all layers of the uterus with each other and the absence of protective barriers between them very soon leads to the transition of endometritis to metroendometritis.

Causes of endometritis

As mentioned above, the first and main cause of endometritis is damage to the mucous membrane of the uterus, leading to the development of the inflammatory process. It must also be understood that simple damage can not entail serious complications. Only the presence of reduced immunity, the presence of slow inflammation and non-compliance with sanitary norms during manipulation can lead to inflammatory changes. The causes of damage can primarily be:

1. Scraping the uterine cavity( medical abortion, scraping with bleeding and suspicion of oncology)
2. Probing the uterine cavity
3. Hysterosalpingography( examination of the uterus and fallopian tubes, most often with the purpose of "purging"in the treatment of infertility)
4. Hysteroscopy( endoscopic examination of the uterine cavity)
5. Setting of intrauterine contraceptives
6. Inaccurate syringing

Special place is occupied by postpartum endometritis, whiche often found even in well-developed countries, which is primarily due to a significant reduction and restructuring of the female immune system. As a rule, the process quickly spreads to the muscular layer and is a formidable complication of the postpartum period.

Endometritis is a polyethological disease - caused by a group of pathogens, with the possible predominance of one. The most frequent pathogens are:

1. Streptococcus group B
2. Intestinal bacillus
3. Klebsiella
4. Enterobacter
5. Proteus
6. Chlamydia
7. Mycoplasma
8. Diphtheria bacillus
9. Tuberculous mycobacterium

In addition, Viruses can act as pathogens, as well as protozoan microorganisms.

Causes of chronic endometritis

The development of chronic endometritis is associated with inadequate treatment of an acute or undiagnosed process in which an infection exists for a long time in tissues. The causative agent may be all listed above.

Symptoms of endometritis

Symptoms of endometritis are sometimes not clearly expressed, and the woman, unfortunately does not pay attention to them, which leads subsequently to a more severe inflammation of not only the mucous membrane, but also the muscular layer of the uterus, which requires hospitalization and inpatient treatment. Consequently, a minimum knowledge of the signs of the endometritis and the causes of its occurrence, timely access to a doctor with these symptoms can prevent his transition to metroendometritis and allow doctors to significantly improve the quality of life of their patients.

Endometritis can be acute and chronic. If the treatment and diagnosis of acute endometritis, as a rule, is not very difficult, then the chronization of the process causes a lot of difficulties, both in diagnostics and in treatment. This is another reason why you should immediately consult a doctor at the first symptoms of endometritis.

Symptoms of acute endometritis

Often, endometritis occurs after an abortion is aborted. It goes without saying that criminal abortion for the most part leads to such a complication due to the almost complete non-observance of sanitary norms. The disease begins with:

1. increase in body temperature to 38-39 ° C;
2. The appearance of serous, serous-purulent and blood-purulent discharge from the genital tract is a particularly important symptom in the compartment with an anamnesis and general malaise that allows differentiating endometritis from inflammatory lesions of the lower genital tract( bacterial vaginosis, colpitis, etc.);
3. the appearance of pains in the lower abdomen, giving
to the rump 4. general malaise.

In such a situation, one should not wait for everything to go by itself and self-medicate - endometritis is an inflammatory disease, and any inflammatory disease has a property that will spread far from the location of the primary focus. Any self-treatment in this situation, postponing a visit to a doctor obstetrician-gynecologist, leads to an imminent increase in the risk of severe purulent-septic complications requiring long-term inpatient treatment, which may well result in amputation of the uterus and the spread of infection-sepsis, with a further fatal outcome. Therefore, when the first symptoms appear, a woman who has recently given birth undergoes an artificial abortion operation, or any invasive diagnostic procedure should immediately consult a doctor and undergo a detailed examination.

In the picture: pink - normal fabric;the rest-inflammatory changes

It should be clarified that the endometrium can only be talked about when there is a prerequisite for it - in the past there were any processes that affected the integrity of the uterine mucosa. In the absence of such talk about the endometrium, when uncharacteristic discharge, pain or any other symptoms appear, it is not legal.

Symptoms of chronic endometritis

For chronic endometritis it is difficult to identify symptoms that would differ from acute form. Symptomatics, in this case, "blurred".The characteristic symptoms of chronic endometritis include:

1. Permanently persistent temperature.
2. Irregular uterine bleeding. Intermenstrual bloody discharge is associated with an increase in permeability of the vessels of the endometrium during the period of ovulation. This change in blood vessels is also observed in healthy women, but blood cells are not visible in the secretions. The causes of uterine bleeding include a decrease in the contractile activity of the uterus and a violation of aggregation properties of platelets.
3. Presence of permanent discharge from the external genital tract, often putrid.
4. Pain during bowel movement.

Chronic endometritis does not prevent conception, which occurs when there is ovulation. In combination with concomitant disorders of ovarian function or other genital diseases, chronic endometritis causes a breakdown in reproductive function - infertility and spontaneous abortions, including habitual ones.

Diagnosis of endometritis

When referring to a doctor, you should tell him in detail all your history and all the symptoms that led to him, because already at this stage it becomes possible to assume the patient has an endometritis. In addition to your anamnesis, the doctor is required:

1. will subject you to a gynecological examination in the mirrors and palpation of the uterus - as a rule, the organ is enlarged in size, painfully reacts to touch;in the process of examination, the doctor will assess the nature of the secretions: their color, odor, consistency, quantity;
2. will take smears - it is due to the simple taking of smears that most of all endometrial pathogens are detected;will take the material for sowing - in this way it is possible to study in more detail the nature of the pathogen by growing it on a special nutrient medium, and also to determine the degree of its response to a particular medical preparation;
3. takes blood from you for clinical and biochemical analysis( as a rule, already in the clinical blood test there will be enough indicators to confirm the diagnosis - in the blood they detect leukocytosis, shift of the leukocyte formula to the left, acceleration of the ESR.);
4. will make ultrasound of the uterus if possible( if you contact with already "advanced" metroendometry in some hospitals the study may be postponed).The main ultrasound signs of endometritis are: thickening of the mucous membrane of the uterus, possibly blood clots and pus( in variants complicated by hemato- and pyometra), the remains of placental tissue, changes in the echogenicity of myometrium tissue in metroendometry. Not infrequently the inflammatory process affects the fallopian tubes and ovaries, which is also clearly visible on ultrasound. With chronic endometrium, in addition to the unevenly thickened endometrium, myometrium with altered echogenicity can also show adhesions in the uterine cavity, which, in turn, can become a real cause of infertility.

The diagnosis of of chronic endometritis can cause difficulties, since the symptoms will be similar to many diseases of the female genital area. In this case, a constant sowing of the same flora, as well as a constant sluggish inflammation, will be indicative.

Treatment of endometritis

In the case of early diagnosis of endometritis, outpatient treatment is possible, but under constant supervision of a gynecologist obstetrician. Typically, the treatment will consist of taking antipyretics and combining antibacterial drugs.

Treatment of acute endometritis

Unfortunately, the absolute majority of women turn to the doctor rather late, which leads to hospitalization and long-term treatment. In this case, the patient's condition and the level of prevalence of the process should be studied in detail, the reasons for which caused it. Most often, treatment begins with:

1. intravenous antibiotic therapy: cephalosporins in combination with metragil and intramuscularly gentamicin. Treatment can last from 5 to 10 days, depending on the need( often cephalosporins are replaced with aminoglycosides);
2. In the presence of "remnants" in the uterine cavity - parts of the fetus with incomplete abortion, the placenta remains after delivery and caesarean section, scraping of the uterine cavity after the infusion( intravenous drip) therapy with antibiotics is shown;
3. application of vitamin therapy and immunomodulators;
4. application of physiotherapy treatment.

Treatment of chronic endometritis

Treatment of chronic endometritis is based on the effect on a particular pathogen. For this, again, it is absolutely necessary to take smears for planting and susceptibility to antibiotics. Apply as a scheme of antibacterial treatment( as in acute endometritis), and antiviral drugs.

A high therapeutic effect has been achieved with the administration of medications, including antibiotics, directly into the uterine mucosa. The method ensures the creation of a high concentration of drugs in the focus of chronic inflammation.

In addition to this, it is mandatory:

1. surgical separation of adhesions( preferably hysteroscopy)
2. hormonal therapy, most often by oral contraceptives, in women who want to become pregnant in the future.

Physiotherapy is widely used in the treatment of both acute and chronic endometritis in the phase, when the first, most difficult period is passed and the woman is compensated. Mandatory in a hospital. Physiotherapeutic methods include: low-intensity UHF therapy( exposure to an ultrahigh-frequency electromagnetic field) with a wavelength of 1-10 m;infrared laser therapy, etc. First of all, it allows to achieve: an improvement in the outflow of fluid and pus accumulated in the uterine cavity and contributes to the strengthening of localreparative functions.

Postpartum endometritis

A special place is occupied by postpartum endometritis, as a frequent and formidable complication of the postnatal process. As a rule, it is inseparable from metroendometritis, proceeds acutely and makes itself felt quite early.

The main causes are the remains of placental tissue and infection due to non-compliance with sanitary norms.

Treatment inpatient. It consists in massive antibacterial therapy, and with the process abating, the removal of all residues from the uterine cavity. Unfortunately, complications that lead to septic complications are rare, and in this case the prognosis may be unfavorable - surgery( amputation of the uterus may be necessary).

In case of breastfeeding, exclude breastfeeding for the duration of antibiotic therapy and for a week or two after it.

Mandatory strict adherence to a diet outside the hospital is not required. Enough: limiting fatty foods, taking large amounts of fluids, eating fruits. In the case of inpatient treatment, it is mandatory to comply with bed rest, a diet with the exclusion of fatty and hard-assimilated food.

As a rule, acute endometritis with timely treatment does not require any special rehabilitation. After the treatment, you need to stay under medical supervision for some time. It is possible to use physiotherapeutic procedures: radon, hydrogen sulphide and air baths, under the supervision of a physiotherapist.

Complications of endometritis

The most serious complications of endometritis include the spread of infection: hematogenous - through the blood;lymphogenous lymph;on the ascending - through the fallopian tubes and downward - the cervix of the uterus, the vagina of the ways. This leads to "infection of the blood" - sepsis. Other complications include:

• Chronicization and outcome in chronic endometritis;
• formation of pyometers - accumulation of pus in the uterine cavity, due to occlusion( obstruction of the cervix and the inability of the pus to go outside);
• connection to the process of the fallopian tubes and appendages - salpingitis and oophoritis;
• pelvioperitonitis - as a result of getting pus in the pelvic cavity.

To late complications arising in inadequate treatment include:

• menstrual cycle disorder;
• infertility;
• persistent pain in the lower abdomen.

This list of complications is not exhausted, since the inflammatory process can be the cause of any pathology that can later emerge. Consequently, early treatment and adequate treatment play a significant role in preventing the development of severe complications.

Folk remedies for endometritis treatment

It is necessary to touch the general entrainment of the population with self-medication by folk remedies. Endometritis is an inflammatory disease that can lead to extremely serious consequences. His treatment - the lot of qualified specialists of obstetrician-gynecologists. Treatment should be carried out using all the newest available means, to achieve maximum effect in a short time. It has been said above that endometritis and metroendometritis are very common in the postpartum period. As a proof of the severity of the pathology, the following figures can be cited: from the 17th century until the beginning of the twentieth scourge of all maternity hospitals around the world, there was maternity( or postnatal) fever-endometritis, successively passing into metroendometritis and sepsis, which at times carried away to 50% of life!all the puerperas. Any experiments with folk self-medication can end badly for the patient.

Endometritis prophylaxis

The prevention of endometritis can include the exclusion of factors predisposing to the onset of an inflammatory disease. Timely treatment of sexually transmitted infections and all the complications that occur during childbirth, the abortion is the most reliable way to prevent endometritis.

In addition, previously applying a baby breast, the appointment of reducing and immunomodulating agents can also serve as a means of nonspecific prevention.

Mandatory examination of a woman after childbirth, ultrasound and gynecological examinations.

However, the greatest preventive measure can be only the attentive attitude of a woman to herself and the timely access to a qualified doctor for an obstetrician-gynecologist.

Doctor obstetrician-gynecologist Kupatadze D.D.