View source for Medicine:Endometritis

{{Infobox medical condition (new)
| name            = Endometritis
| synonyms        = Postpartum endometritis, endomyometritis
| image           = Endometritis - 2 - cropped - very high mag.jpg
| caption         = [[Micrograph]] showing a chronic endometritis with the characteristic [[Biology:Plasma cell|plasma cell]]s. Scattered [[Biology:Neutrophil|neutrophil]]s are also present. H&E stain.
| pronounce       = 
| field           = [[Medicine:Gynaecology|Gynaecology]], [[Medicine:Obstetrics|obstetrics]]
| symptoms        = [[Medicine:Fever|Fever]], lower abdominal pain, abnormal vaginal bleeding, [[Medicine:Vaginal discharge|discharge]]<ref name=Hac2015/>
| complications   = 
| onset           = 
| duration        = 
| types           = Acute, chronic<ref name=Dal2010/>
| causes          = [[Medicine:Infection|Infectious]]<ref name=Dal2010/>
| risks           = [[Medicine:Abortion|Abortion]], [[Medicine:Menstruation|menstruation]], [[Medicine:Childbirth|childbirth]], placement of an IUD, douching<ref name=Lobo2016/><ref name=Dal2010/>
| diagnosis       = 
| differential    = 
| prevention      = 
| treatment       = Antibiotics<ref name=Hac2015/>
| medication      = 
| prognosis       = Good with treatment<ref name=Fer2014/>
| frequency       = 2% (following vaginal delivery),<br/>10% (following scheduled C-section)<ref name=Gab2012/>
| deaths          = 
}}
<!-- Definition and symptoms -->
'''Endometritis''' is [[Medicine:Inflammation|inflammation]] of the inner lining of the [[Biology:Uterus|uterus]] (endometrium).<ref name=Cr2011>{{cite book |last1=Crum |first1=Christopher P. |last2=Lee |first2=Kenneth R. |last3=Nucci |first3=Marisa R. |title=Diagnostic Gynecologic and Obstetric Pathology E-Book |date=2011 |publisher=Elsevier Health Sciences |isbn=978-1455708956 |page=430 |url=https://books.google.com/books?id=d91mO9WYtPYC&pg=PA430 |language=en}}</ref> Symptoms may include [[Medicine:Fever|fever]], lower abdominal pain, and abnormal vaginal bleeding or [[Medicine:Vaginal discharge|discharge]].<ref name=Hac2015/><ref name=Fer2014>{{cite book |last1=Ferri |first1=Fred F. |title=Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1 |date=2014 |publisher=Elsevier Health Sciences |isbn=9780323084307 |page=423 |url=https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA423 |language=en}}</ref> It is the most common cause of [[Medicine:Postpartum infections|infection after childbirth]].<ref name=Ar2013>{{cite book |last1=Arora |first1=Mala |last2=Walavalkar |first2=Rajalaxmi |title=World Clinics: Obstetrics & Gynecology: Postpartum Hemorrhage |date=2013 |publisher=JP Medical Ltd |isbn=9789350904244 |page=237 |url=https://books.google.com/books?id=Ie-8AQAAQBAJ&pg=PA237 |language=en}}</ref><ref name=Hac2015>{{cite book |title=Hacker & Moore's essentials of obstetrics and gynecology |date=2015 |publisher=Elsevier Canada |isbn=9781455775583 |pages=276–290 |edition=6 |chapter=Cover of Hacker & Moore's Essentials of Obstetrics and Gynecology}}</ref> It is also part of spectrum of diseases that make up [[Medicine:Pelvic inflammatory disease|pelvic inflammatory disease]].<ref>{{cite book |title=Current diagnosis & treatment : obstetrics & gynecology |date=2012 |publisher=McGraw-Hill Education |isbn=978-0071638562 |page=Chapter 43 |edition=11 |chapter=Sexually Transmitted Diseases & Pelvic Infections}}</ref>

<!-- Cause and diagnosis -->
Endometritis is divided into acute and chronic forms.<ref name=Dal2010>{{cite book |last1=Dallenbach-Hellweg |first1=Gisela |last2=Schmidt |first2=Dietmar |last3=Dallenbach |first3=Friederike |title=Atlas of Endometrial Histopathology |date=2010 |publisher=Springer Science & Business Media |isbn=9783642015410 |page=135 |url=https://books.google.com/books?id=q5iDbKMK5Q0C&pg=PA135 |language=en}}</ref> The acute form is usually from an [[Medicine:Infection|infection]] that passes through the [[Medicine:Cervix|cervix]] as a result of an [[Medicine:Abortion|abortion]], during [[Medicine:Menstruation|menstruation]], following [[Medicine:Childbirth|childbirth]], or as a result of douching or placement of an IUD.<ref name=Dal2010/><ref name=Lobo2016/> Risk factors for endometritis following delivery include [[Medicine:Caesarean section|Caesarean section]] and prolonged rupture of membranes.<ref name=Hac2015/> Chronic endometritis is more common after [[Medicine:Menopause|menopause]].<ref name=Dal2010/> The diagnosis may be confirmed by endometrial biopsy.<ref name=Lobo2016>{{cite book |last1=Lobo |first1=Rogerio A. |last2=Gershenson |first2=David M. |last3=Lentz |first3=Gretchen M. |last4=Valea |first4=Fidel A. |title=Comprehensive Gynecology E-Book |date=2016 |publisher=Elsevier Health Sciences |isbn=9780323430036 |page=548 |url=https://books.google.com/books?id=2xN9DAAAQBAJ&pg=PA548 |language=en}}</ref> [[Physics:Ultrasound|Ultrasound]] may be useful to verify that there is no retained tissue within the uterus.<ref name=Fer2014/>

<!-- Treatment and epidemiology -->
Treatment is usually with [[Chemistry:Antibiotic|antibiotic]]s.<ref name=Hac2015/> Recommendations for treatment of endometritis following delivery includes [[Chemistry:Clindamycin|clindamycin]] with [[Chemistry:Gentamicin|gentamicin]].<ref name=Mac2015>{{cite journal |last1=Mackeen |first1=AD |last2=Packard |first2=RE |last3=Ota |first3=E |last4=Speer |first4=L |title=Antibiotic regimens for postpartum endometritis. |journal=The Cochrane Database of Systematic Reviews |date=2 February 2015 |volume=2015 |issue=2 |pages=CD001067 |doi=10.1002/14651858.CD001067.pub3 |pmid=25922861|pmc=7050613 }}</ref> Testing for and treating [[Medicine:Gonorrhea|gonorrhea]] and [[Medicine:Chlamydia|chlamydia]] in those at risk is also recommended.<ref name=Wil2016/> Chronic disease may be treated with [[Chemistry:Doxycycline|doxycycline]].<ref name=Wil2016>{{cite book |title=Williams Gynecology |date=2016 |publisher=McGraw Hill Professional |isbn=9780071849081 |edition=3 |chapter=8}}</ref> Outcomes with treatment are generally good.<ref name=Fer2014/>

<!-- Epidemiology and history -->
Rates of endometritis are about 2% following vaginal delivery, 10% following scheduled C-section, and 30% with rupture of membranes before C-section if preventive antibiotics are not used.<ref name=Gab2012>{{cite book |last1=Gabbe |first1=Steven G. |title=Obstetrics: Normal and Problem Pregnancies |date=2012 |publisher=Elsevier Health Sciences |isbn=978-1437719352 |page=1146 |url=https://books.google.com/books?id=-3ufSTqeb6cC&pg=PA1146 |language=en}}</ref> The term "endomyometritis" may be used when inflammation of the endometrium and the myometrium is present.<ref name=Hub2007>{{cite book |author1=Hubert Guedj |author2=Baggish, Michael S. |author3=Valle, Rafael Heliodoro |title=Hysteroscopy: visual perspectives of uterine anatomy, physiology, and pathology |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2007 |pages=488 |isbn=978-0-7817-5532-0 }}</ref> The condition is also relatively common in other animals such as cows.<ref>{{cite book |last1=Noakes |first1=David E. |title=Arthur's Veterinary Reproduction and Obstetrics E-Book |date=2009 |publisher=Elsevier Health Sciences |isbn=9780702039904 |page=411 |url=https://books.google.com/books?id=W5TdAwAAQBAJ&pg=PA411 |language=en}}</ref>

==Symptoms==
Symptoms may include [[Medicine:Fever|fever]], lower abdominal pain, and abnormal vaginal bleeding or [[Medicine:Vaginal discharge|discharge]].<ref name=Hac2015/><ref name=Fer2014>{{cite book |last1=Ferri |first1=Fred F. |title=Ferri's Clinical Advisor 2015 E-Book: 5 Books in 1 |date=2014 |publisher=Elsevier Health Sciences |isbn=9780323084307 |page=423 |url=https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA423 |language=en}}</ref>

== Types ==
=== Acute endometritis ===
Acute endometritis is characterized by infection. The organisms most often isolated are believed to be because of compromised abortions, delivery, medical instrumentation, and retention of placental fragments.<ref>{{cite web|url=http://www.pregmed.org/endometritis.htm|title=Endometritis - Pregnancy Articles|date=21 November 2013|website=pregmed.org|access-date=11 April 2018}}</ref> There is not enough evidence for the use of prophylactic antibiotics to prevent endometritis after manual removal of placental in vaginal birth.<ref>{{cite journal|last1=Chongsomchai|first1=C|last2=Lumbiganon|first2=P|last3=Laopaiboon|first3=M|title=Prophylactic antibiotics for manual removal of retained placenta in vaginal birth|journal=The Cochrane Database of Systematic Reviews|date=Oct 20, 2014|volume=10|issue=10|pages=CD004904|pmid=25327508|doi=10.1002/14651858.CD004904.pub3|pmc=7390442}}<!--|access-date=28 October 2014--></ref> Histologically, neutrophilic infiltration of the endometrial tissue is present during acute endometritis. The clinical presentation is typically high fever and purulent vaginal discharge. Menstruation after acute endometritis is excessive and in uncomplicated cases can resolve after 2 weeks of [[Chemistry:Clindamycin|clindamycin]] and [[Chemistry:Gentamicin|gentamicin]] IV antibiotic treatment.

In certain populations, it has been associated with ''[[Biology:Mycoplasma genitalium|Mycoplasma genitalium]]'' and [[Medicine:Pelvic inflammatory disease|pelvic inflammatory disease]].<ref name="pmid11888591">{{cite journal  |vauthors=Cohen CR, Manhart LE, Bukusi EA, etal |title=Association between Mycoplasma genitalium and acute endometritis |journal=Lancet |volume=359 |issue=9308 |pages=765–6 |date=March 2002 |pmid=11888591 |doi=10.1016/S0140-6736(02)07848-0 |s2cid=36191700 }}</ref><ref name=Sternak>{{cite journal|last1=Ljubin-Sternak|first1=Suncanica|last2=Mestrovic|first2=Tomislav|title=Review: Chlamydia trachonmatis and Genital Mycoplasmias: Pathogens with an Impact on Human Reproductive Health|journal=Journal of Pathogens|page= 3 |date=2014|volume=2014|issue=183167|doi=10.1155/2014/183167|pmid=25614838|pmc=4295611|doi-access=free}}</ref>

=== Chronic endometritis ===

Chronic endometritis is characterized by the presence of plasma cells in the stroma. Lymphocytes, eosinophils, and even lymphoid follicles may be seen, but in the absence of plasma cells, are not enough to warrant a histologic diagnosis. It may be seen in up to 10% of all endometrial biopsies performed for irregular bleeding. The most common organisms are [[Biology:Chlamydia trachomatis|Chlamydia trachomatis]] ([[Medicine:Chlamydia infection|chlamydia]]), [[Biology:Neisseria gonorrhoeae|Neisseria gonorrhoeae]] ([[Medicine:Gonorrhea|gonorrhea]]), Streptococcus agalactiae (Group B Streptococcus), [[Biology:Mycoplasma hominis|Mycoplasma hominis]], [[Medicine:Tuberculosis|tuberculosis]], and various viruses. Most of these agents are capable of causing chronic [[Medicine:Pelvic inflammatory disease|pelvic inflammatory disease]] (PID). Patients with chronic endometritis may have an underlying cancer of the cervix or endometrium (although infectious cause is more common). Antibiotic therapy is curative in most cases (depending on underlying cause), with fairly rapid alleviation of symptoms after only 2 to 3 days. Women with chronic endometritis are also at a higher risk of pregnancy loss and treatment for this improves future pregnancy outcomes.<ref name="pmid33025403">{{cite journal | vauthors = Buzzaccarini G, Vitagliano A, Andrisani A, Santarsiero CM, Cicinelli R, Nardelli C, Ambrosini G, Cicinelli E | title = Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review | journal = Journal of Assisted Reproduction and Genetics | volume = 37 | issue = 12 | pages = 2897–2911 | date = December 2020 | pmid = 33025403 | doi = 10.1007/s10815-020-01955-8 | pmc = 7714873 | doi-access = free }}</ref><ref name="pmid33274569">{{cite journal | vauthors = Rimmer MP, Fishwick K, Henderson I, Chinn D, Al Wattar BH, Quenby S | title = Quantifying CD138+ cells in the endometrium to assess chronic endometritis in women at risk of recurrent pregnancy loss: A prospective cohort study and rapid review | journal = The Journal of Obstetrics and Gynaecology Research | volume = 47| issue = 2| pages = 689–697| date = December 2020 | pmid = 33274569 | doi = 10.1111/jog.14585 | s2cid = 227283325 | url = http://wrap.warwick.ac.uk/144631/1/WRAP-quantifying-CD138%2Bcells-endometrium-assess-chronic-endometritis-women-risk-recurrent-pregnancy-loss-Al%20Wattar-2020.pdf }}</ref>

Chronic granulomatous endometritis is usually caused by tuberculous. The granulomas are small, sparse, and without [[Medicine:Caseous necrosis|caseation]]. The granulomas take up to 2 weeks to develop and since the endometrium is shed every 4 weeks, the granulomas are poorly formed.

In human medicine, pyometra (also a veterinary condition of significance) is regarded as a form of chronic endometritis seen in elderly women causing stenosis of the cervical os and accumulation of discharges and infection. Symptom in chronic endometritis is blood stained discharge but in pyometra the patient complaints of lower abdominal pain.

== Pyometra ==
Pyometra describes an accumulation of [[Medicine:Pus|pus]] in the uterine cavity.<ref name=ACVS>{{cite web | title = Pyometra | publisher = American College of Veterinary Surgeons | year = 2004 | url = http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/PyometrainDogsCats/ | access-date = 2006-12-14 | url-status = dead | archive-url = https://web.archive.org/web/20060221200356/http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/PyometrainDogsCats/ | archive-date = 2006-02-21 }}</ref>  In order for pyometra to develop, there must be both an infection and blockage of cervix. Signs and symptoms include lower abdominal pain (suprapubic), rigors, fever, and the discharge of pus on introduction of a sound into the uterus. Pyometra is treated with antibiotics, according to culture and sensitivity.<ref>{{cite journal|last1=Höglund|first1=Odd Viking|last2=Lövebrant|first2=Johanna|last3=Olsson|first3=Ulf|last4=Höglund|first4=Katja|title=Blood pressure and heart rate during ovariohysterectomy in pyometra and control dogs: a preliminary investigation|journal=Acta Veterinaria Scandinavica|date=17 November 2016|volume=58|issue=1|page=80|doi=10.1186/s13028-016-0263-y|pmc=5112883|pmid=27855712 |doi-access=free }}</ref>

==See also==
*[[Medicine:Maternal death|Maternal death]]
*Puerperal fever

== References ==
{{reflist}}

== External links ==
{{Medical resources
|  DiseasesDB     = 4283 
|  ICD10          = {{ICD10|N|71||n|70}} 
|  ICD9           = {{ICD9|615.9}} 
|  ICDO           =  
|  OMIM           =  
|  MedlinePlus    = 001484 
|  eMedicineSubj  = med 
|  eMedicineTopic = 676 
|  eMedicine_mult = {{eMedicine2|ped|678}} 
|  MeshID         = D004716
}}
{{Diseases of the pelvis and genitals}}

[[Category:Inflammations]]
[[Category:Wikipedia medicine articles ready to translate]]

{{Sourceattribution|Endometritis}}