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Female Reproductive System ORGAN SYSTEMS

Endometritis

Introduction

Endometritis is a persistent inflammation of the endometrial mucosa often caused by pathogens ascending into the uterine cavity.


Aetiology

Pregnancy:

Bacteria easily reach uterus during parturition d/t:

  • Shed mucous plug 
  • Widened cervix
  • Membrane rupture

Other risk factors:

  • Prolonged labour
  • Premature rupture of membrane (PROM)
  • Caesarian section
  • IUD insertion

STI:

  • Chlamydia
  • Neisseria gonorrhoea

Tuberculosis


Pathophysiology

endometritis


Clinical features

Acute endometritis:

  • Fever
  • Abnormal uterine bleeding (AUB)
  • Lower abdominal pain
  • Dysuria
  • Dyspareunia

During puerperium:

  • Purulent & foul-smelling lochia

Chronic endometritis:

  • Mild/no symptoms of acute endometritis

Complications

  • Myometrium → Endomyometritis
  • Fallopian tube → Salpingitis
  • Ovaries → Oophoritis
  • Peritoneum → Peritonitis
  • During pregnancy → Chorioamnionitis

Pyometra: Accumulation of pus in the uterine cavity due to infection + blockage of cervix.

  • Lower abdominal pain (suprapubic)
  • Rigors, fever
  • Discharge of pus on introduction of a sound into the uterus

Chronic endometritis:

  • Infertility
  • Tuberculosis → Asherman’s syndrome
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Hysteroscopic finding of chronic endometritis. The focal hyperemic area allowed chronic endometritis to be diagnosed in a woman with a history of repeated implantation failure | Photo: HJ Park, MD

Asherman’s syndrome: Formation of scar tissue in the uterine cavity

Severe inflammation

Basal layer unable to regenerate functional layer

Basal layer fibrosis
(normal tissue replaced by collagen)

Fibrous bands
(adhesions/synechia)

Uterine walls stick to each other

Absence of menstrual bleeding

Severe cases:
Infertility
Recurrent pregnancy loss


Management

  • Post-partum endometritisClindamycin + Gentamycin
  • Retained products of conception: Dilation & curettage (D&C)
  • Chlamydia/Neisseria gonorrhoeaeDoxycycline + ceftriaxone
  • TuberculosisAnti-TB drugs

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