General characteristics of the disease.
Endometritis is an inflammation of the mucous membrane of the inner part of the uterus.
The factors provoking the onset of endometritis include stress, avitaminosis, chronic diseases, intoxication and other phenomena that cause a decrease in immunity.
There is a high probability of the appearance of the first symptoms of endometritis after trauma to the cervix during abortion, the introduction of an intrauterine device, diagnostic or therapeutic curettage or childbirth.
Acute endometritis develops as a result of the primary inflammatory process of the mucosal epithelium of the uterus. Infection of the ascending type leads to it: through the broken cervical barrier deep into the uterus.
In acute endometritis, inflammation can spread to the muscular layer of the organ. In this case, the disease passes into a complicated form of acute endometritis – endomyometritis. In the most severe cases of infection spreading to all layers of the uterine wall, panmetritis develops.
Chronic endometritis most often occurs as a consequence of the untreated acute endometritis in time. Approximately half of the cases of labor complicated by deep cervical ruptures without adequate follow-up treatment result in chronic endometritis.
Other possible causes of chronic endometritis are multiple curettage of the uterus, remains of suture material after delivery through caesarean section. Significantly burdens the course of chronic endometritis vaginal dysbacteriosis, caused by an increase in the vaginal environment, the number of opportunistic bacteria.
Symptoms of endometritis.
Acute endometritis begins with a sharp rise in temperature. Among the symptoms of acute endometritis, also called severe pain in the lower abdomen and a feeling of chill. Signs of endometritis of this type include still abundant purulent or suppository-purulent vaginal discharge.
The duration of acute endometritis is 7-10 days. Without treatment, the disease passes into the endometritis of a chronic form or ends with the generalization of the process.
thrombophlebitis of the veins of the small pelvis.
Relapse of the disease is characterized by the following signs of endometritis of chronic form: menstrual cycle disorders, pulling pains in the lower abdomen, uninfluous serous-purulent vaginal discharge.
In a history of patients with symptoms of endometritis of a chronic type, spontaneous abortions are not uncommon. The increase in temperature does not refer to the signs of endometritis of the chronic form. The patient’s state of health, as a rule, is not severely disturbed.
Diagnosis of endometritis.
In the diagnosis of endometritis an important role is played by the collection of anamnesis – the regularity of the menstrual cycle, the presence in the history of patient intrauterine interventions, the use of intrauterine contraceptives, the cases of unprotected sex with a non-regular partner.
During the physical examination, the following signs of endometritis can be found.
increase in the size of the uterus.
compaction of the organ.
special sensitivity of the lateral walls of the organ during palpation.
In laboratory blood tests of patients with symptoms of acute endometritis, leukocytosis, an increase in the level of ESR and a C-reactive protein that indicates inflammation in the body are diagnosed. An important role in the diagnosis of acute and chronic endometritis is also played by microscopy of the vaginal smear. To confirm the signs of endometritis, ultrasound of the pelvic organs and a histological study of scraping of the endometrium of the uterus are additionally applied.
Treatment of endometritis.
In the treatment of acute endometritis, the use of antibiotic therapy is mandatory, since the cause of primary inflammation of the uterine mucosa in most cases of infectious etiology.
After arresting the acute process, the treatment of endometritis is supplemented by the use of anti-inflammatory and physiotherapy, fortified vitamin preparations and immunomodulators. To prevent the worsening of the process, the patient is recommended to take oral contraceptives for at least 3-5 menstrual cycles.
Treatment of endometritis of chronic form is desirable to begin on the first day of the menstrual cycle. If the disease is no longer infectious, but a functional one, caused by the prescription of the process, cyclic hormone therapy is used in the treatment of endometritis.
Surgical treatment of endometritis is used in case of complication of the disease with polyps and intrauterine shrinkage. Removal of polyps and scraping endometrium of the uterus with numerous signs of scarring contributes to the renewal of tissues, the restoration of the menstrual cycle and the successful bearing of the fetus.
Prophylaxis of endometritis.
Endometritis is often the cause of women’s problems associated with pregnancy. It can also lead to placental insufficiency and massive postpartum hemorrhage. For the prevention of endometritis, the exclusion of casual sex without barrier methods of contraception is recommended.
The same type of contraceptive is preferably used for the prevention of pregnancy, in order to prevent the use of medical abortion. Therefore, such gynecological diseases as endometritis, it is necessary to begin to treat as early as possible, and necessarily to bring the treatment to an end.