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Endometritis

Definition

Endometritis is an inflammation or irritation of the lining of the uterus (endometrium).

See also: Pelvic inflammatory disease

Causes, incidence, and risk factors

The usual cause of endometritis is infection, such as

• Chlamydia
• Gonococcal endometritis
• Salpingitis  
• Tuberculous endometritis
• Purulent endometritis

Endometritis may also occur from:

• Childbirth
• Abortion (therapeutic, elective, or spontaneous)
• Intrauterine device (IUD) insertion
• Surgery or other gynecological procedures that require insertion of medical instruments

Other risk factors may include a history of acute salpingitis, acute cervicitis, and other pelvic infections, including many sexually transmitted diseases.

Symptoms

• General discomfort, uneasiness, or ill feeling (malaise)
• Fever (ranging from 100 to 104 degrees Fahrenheit)
• Lower abdominal or pelvic pain (uterine pain)
• Abnormal vaginal bleeding
• Abnormal vaginal discharge
  • Increased amount
  • Unusual color, consistency, or odor
• Discomfort with bowel movement (constipation may occur)
• Abdominal distention

Signs and tests

The health care provider will perform a physical exam. Exam of the lower abdomen may show abdominal tenderness. Bowel sounds may be decreased. A pelvic exam may reveal a tender uterus and cervix. There may be cervical discharge.

The following tests may be performed:

• WBC (white blood count)
• ESR (sed rate)
• Endocervical cultures for chlamydia, gonorrhea, and other organisms
• Endometrial biopsy
• Laparoscopy

Treatment

Complicated cases (those occurring after childbirth, or those involving severe infection) may require the patient to be admitted to a hospital. The patient may receive  intravenous antibiotics, followed by antibiotics taken by mouth.

Rest and hydration are important. Treatment for sexual partner(s), when appropriate, and the use of condoms throughout the course of treatment, are essential.

Expectations (prognosis)

Most cases of endometritis go away with antibiotics. Untreated endometritis can lead to more serious infection and complications with pelvic organs, reproduction, and general health.

Complications

• Pelvic peritonitis (generalized pelvic infection)
• Pelvic or uterine abscess formation
• Septicemia
• Septic shock
• Infertility

Calling your health care provider

Call for an appointment with your health care provider if symptoms of endometritis occur (particularly if within several days after childbirth, abortion, or IUD insertion).

Prevention

• "Safer" sexual practices
• Early diagnosis and adequate treatment (for partners also) of sexually transmitted diseases
• Finish all medications and follow up with your health care provider after any gynecological procedures

The risk of endometritis is reduced by the careful, sterile techniques used by appropriate providers in performing deliveries, abortions, IUD insertions, and other gynecological procedures.

References

Faro S. Postpartum endometritis. Clin Perinatol.  2005; 32(3): 803-14. 

Stenchever A. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:708.

Review Date:5/10/2006
Reviewed By:Melanie N. Smith, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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