Difficulties with conception and pregnancy are a significant reason for a couple to visit a reproductive specialist at the "Boholiuby" Medical Center. Modern gynecology faces many diseases that directly affect a woman's reproductive health and her quality of life. And often, one of the causes of female infertility is a disease such as endometritis.
Endometritis is an inflammation of the inner lining of the uterus caused by an infection. The spread of inflammation to the muscle layer is called endomyometritis, and to the outer layer of the uterus - endoparametritis. Endometritis is often associated with recent pregnancy, although it can affect any woman.
Postpartum endometritis is the most common infection in women who have recently given birth. The development of endometritis is facilitated by traumatic stress on the birth canal, which allows the vaginal microflora to enter the uterine cavity. It most often occurs during prolonged labor and cesarean section. During pregnancy, the mucous plug prevents bacterial translocation, but when the cervix dilates and the fetal membranes rupture during childbirth, the likelihood of bacterial colonization of the uterine cavity increases.
Acute endometritis, not associated with pregnancy, is usually a complication of sexually transmitted infections and, less commonly, bacterial vaginosis. Its development can also be promoted by invasive gynecological procedures, such as endometrial biopsy and intrauterine device (IUD) insertion. Chronic endometritis is an inflammatory disease lasting at least 30 days, although symptoms are often less severe than in acute endometritis.
The main risk factors are:
• Multiple sexual partners;
• Non-use of condoms, history of sexually transmitted diseases;
• Recent insertion of an intrauterine device;
• Diabetes and obesity.
Potentially responsible microorganisms include: Chlamydia trachomatis; Neisseria gonorrhoeae; Gardnerella vaginalis; Mycoplasma genitalium; Streptococcus and Staphylococcus sp.; Haemophilus influenzae; Escherichia coli.
How does endometritis manifest?
Postpartum endometritis usually presents with a clinical picture characterized by fever, pain in the pelvic and abdominal area, postpartum bleeding with pus, an unpleasant odor, and particularly heavy bleeding. The patient may also complain of malaise, headache and chills, a sharp decrease in blood pressure, and confusion.
Acute endometritis: Abdominal and/or pelvic pain; pain during sexual intercourse (dyspareunia) is often present. Symptoms usually progress quickly, within a few days, but less commonly may progress more slowly, lasting up to several weeks.
What are the complications of endometritis?
If left untreated, postpartum endometritis can be fatal (17% of cases). Acute endometritis itself has a favorable prognosis, but damage to the fallopian tubes can lead to permanent infertility due to tubal obstruction. A minority of patients develop infectious complications such as: sepsis and toxic shock syndrome, abscess, thrombophlebitis, necrotizing fasciitis.
Treatment of endometritis usually involves prescribing antibiotics targeted against the specific pathogen after appropriate laboratory testing. In cases of postpartum endometritis, intravenous antibiotics may be administered in a hospital setting, as well as in cases with a high risk of complications. Significant clinical improvement is expected within 48–72 hours in such patients. Patients with acute and chronic endometritis are prescribed oral therapy whenever possible.
Is there a chance of a successful pregnancy with endometritis? Yes, but without treatment, endometritis seriously reduces the likelihood of conception and carrying a pregnancy to term. After successful therapy, the chances of pregnancy increase significantly.
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