Acute Endometritis

Description of the Disease

Acute endometritis is a sudden inflammation of the endometrium (the lining of the uterus). It is classified as one of the pelvic inflammatory diseases.

The inflammation may be caused by Staphylococcus spp., Streptococcus spp., Neisseria gonorrhoeae, Trichomonas vaginalis, viruses, Escherichia coli, Candida spp., mycoplasmas, chlamydia, and Gardnerella vaginalis. Neisseria gonorrhoeae and Trichomonas vaginalis, both sexually transmitted pathogens, primarily affect the endometrium and create favorable conditions for secondary bacterial infection.

Acute endometritis may also develop following trauma to the uterine lining, such as after an improperly performed abortion, other uterine surgical procedures, prolonged use of an intrauterine device for more than 5 years, poor menstrual or sexual hygiene, complicated childbirth (for example, premature rupture of membranes), or injury to the endometrium.

Risk factors for developing endometritis include the use of contraceptive devices, smoking, drug use, and vaginal infections.

Endometritis may involve the entire endometrium or only a portion of it. Mild cases may resolve spontaneously, with heavier menstrual bleeding resulting from the shedding of the inflamed endometrial tissue. In more severe cases, the inflammation extends into the muscular layer of the uterus, and the infection may spread to surrounding organs, leading to complications, including sepsis.

Symptoms

Symptoms include a fever above 38°C, chills, severe lower abdominal pain that may radiate to the groin, tenderness of the cervix and uterus during a pelvic examination, and abundant watery or purulent vaginal discharge with a bloody odor.

Diagnosis

Diagnosis is based on a gynecological examination, which typically reveals an enlarged, soft, and tender uterus, along with abundant purulent, watery, or bloody vaginal discharge. A vaginal or cervical swab is collected to identify the causative pathogen. Ultrasound examination may show dilation of the uterine cavity. Blood tests typically reveal leukocytosis, indicating inflammation.

Treatment

Mild acute endometritis can usually be treated at home with bed rest, ice packs applied to the lower abdomen, adequate fluid intake, a nutritious and easily digestible diet, antibiotics, and other medications targeted at the causative pathogen.

More severe cases require hospitalization. Treatment includes careful monitoring, intravenous antibiotics, antipyretic and pain-relieving medications, and other supportive therapy as needed. Surgical treatment may be required if complications develop or are likely to occur, with every effort made to preserve fertility.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology