What You Should Know About Endometritis

    Updated 17 March 2020 |
    Published 02 November 2018
    Fact Checked
    Medically reviewed by Dr. Anna Targonskaya, Obstetrician and gynecologist
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    Read the article to the end to learn about endometritis symptoms and ways to prevent them.

    What is endometritis?

    Endometritis is the inflammation of endometrium associated with the retained products of conception following delivery, miscarriage, abortion, or with foreign body like an IUD. Retained material in uterus promotes infection by bacterial flora from vagina or intestinal tract.

    Following vaginal delivery, the rate of endometritis is 2% and 6-27% after a caesarean section.   

    What causes endometritis?

    The following are possible endometritis causes:

    • Sexually transmitted infections (STIs)
    • Tuberculosis.
    • Intrauterine foreign bodies or polyps
    • Instrumentation of the uterine cavity (e.g. hysteroscopy) 
    • Intrauterine devices (IUD) are identified as causative actions. The catheters might introduce infection after it overcomes the cervical keeper
    • Placenta remnants left inside the uterus after delivery, a miscarriage or surgical pregnancy termination.

    Endometritis risk factors

    Possible endometritis risk factors are the following:

    • Delivery via C-section
    • Intrapartum chorioamnionitis 
    • Prolonged labor
    • Multiple pelvic examinations
    • Internal fetal monitoring with the use of scalp electrodes or intrauterine pressure catheters
    • Anemia
    • Prelabour rupture of membranes –incidence increases with the latency to onset of labour.

    Typical symptoms of endometritis

    Majority of endometritis complications relate to the menstrual cycle that includes blood flow and predictions of menstruation. Having sexual intercourse during periods increases the risk of contracting an STI.

    Usually, the following symptoms are characteristic of endometritis:

    • Fever 
    • Abnormal vaginal bleeding 
    • Subinvolution of the uterus 
    • Tender bulky uterus on abdominal examination
    • Pain during sex (dyspareunia)
    • Elevated WBC (white blood cells) count.

    How is endometritis diagnosed?

    Only a licensed doctor can diagnose endometritis based on the developed symptoms. 

    The doctor will look for physical signs of endometritis with a pelvic exam. During this exam, the doctor will feel different areas of the pelvic to check for any abnormalities. 

    To diagnose endometritis, cultures are taken from the cervix to rule out STIs or any bacterial infection. Eventually, the doctor might be unable to confirm endometritis, but the pathogens are identified via the endometrial biopsy. 

    Once blood tests are assessed and cultures of urine samples, blood and vaginal discharge are obtained, vaginal ultrasound is done to view the uterus on the inside.

    A much better understanding of the tissues and organs inside the body is seen with Magnetic Resonance Imaging (MRI). Moreover, MRI scans also give the doctor more coverage for endometriosis surgery and determine the location and size of any endometrial implants. CT scans have a similar approach where the X-ray machine shows images of the needed area, for example abdomen. Endometritis ultrasound images can also provide some value in diagnosis.

    Hysteroscopy is carried out to check the lining of the uterus. Small camera and light scope is placed inside the cervix and vagina. The doctors visually study the lining, and a sample of tissue can also be withdrawn. 

    Possible complications

    Endometritis complications can include:

    • Infertility: Endometrial biopsy plays a great role in evaluating fertility.
    • Pelvic infection: pelvic abscess, pelvic peritonitis along with salpingitis, tubo-ovarian abscess, septic thrombophlebitis
    • Septic shock that can eventually lead to death.

    How is endometritis treated?

    Immediate treatment requires antibiotic use to prevent any further complications. 

    Immediate ingestion of antibiotic is needed to prevent any further complications of the pathogen. All antibiotics are to be taken timely and with the right dose. Symptoms and treatment are more severe after childbirth where hospitalization and uterine curettage is necessary. In such surgical cases, pus and infected tissue requires urgent removal.

    For acute cases, that may have no connection to pregnancy, is contracted due to STIs or invasive gynecological procedures. Surgical management is not required in acute cases, but curettage and dilation might be advised by the doctor to retain conception. In case the infection is unresponsive, hysterectomy is a viable option. Endometritis surgery is the last resort. 

    For chronic endometritis treatment, doxycycline is preferred. Doxycycline is taken orally and along with treating acne, pimples, abscesses, it targets bacteria and protozoa such as chlamydia, and syphilis. Doxycycline is a cough syrup taken one or two times daily as prescribed by your doctor. 

    Can endometritis be prevented?

    As very often endometritis is caused by STIs, so prevention from sexually transmitted illnesses is required. Safe sex practices ought to be employed along with proper condom use.

    Postpartum endometritis can be prevented by starting prophylactic antibiotic therapy with your doctor. The benefit in laboring women is established as is prevents acute and chronic endometritis.

    In conclusion

    We have established a few key points about endometritis above. If you’re undergoing similar symptoms, treatment, and preventing others from STIs is the best possible step. With all medicinal inventions by our side, you can expect to rid yourself of major symptoms.

    However, if you believe you have contracted an STI, or do not understand the reason for your abdominal pain, always consult a doctor or physician before you check online: professionals will provide you with all-important information about your condition.

    History of updates

    Current version (17 March 2020)

    Medically reviewed by Dr. Anna Targonskaya, Obstetrician and gynecologist

    Published (02 November 2018)

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