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
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
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 endometritis: Clindamycin + Gentamycin
- Retained products of conception: Dilation & curettage (D&C)
- Chlamydia/Neisseria gonorrhoeae: Doxycycline + ceftriaxone
- Tuberculosis: Anti-TB drugs