Endometrium
• Endometrium is the lining of
uterus. It consists of columnar
epithelium and stroma. It has a two
layers;
1) Functional built after end of
mensturation during the first part
of the previous menstural cycle. It
sheds during mensturation .
2) Basal layer is not shed during
menstural cycle and functional
layer develops from it.
INTRODUCTION
• Endometritis refer to inflammation of the endometrium ,the lining of the
uterus.
• In addition to the endometrium, inflammation may involve the myometrium
and occasionally the parametrium.
• Endometritis is an inflammation of the inner lining of the uterus or
endometrium.
TYPES OF ENDROMETRITIS
• Acute endometritis:acute endometritis is characterized by infection.
• The most common cause of infection is after abortion, after delivery
medical instrumentation or multiple vaginal examination.
• Chronic endometritis: chronic endometritis is a persistent
inflammation of the lining of the uterine cavity.
• It is a condition frequently associated repeated unexplained
implementation failure at in vitro fertilization, recurrent miscarriage,
as well as poor obstetric outcomes such as preterm labor.
CAUSES
Endometritis is caused by infection such as gonorrhea, tuberculosis or
mixture of normal vaginal bacteria.
Endometritis is more likely to occur after miscarriage or child birth,
especially after miscarriage or child birth especially after a long labour
or cesarian section.
A medical procedure that involves entering the uterus through the
cervix will increase the risk of developing endometritis, this includes
hyterescopy, and placement of an IUCD.
Cont..
• Endometritis can occur at the same time as other pelvic infection such
as acute salphingitis, acute cervicitis and many sexually transmitted
infection.
RISK FACTOR OF ENDOMETRITIS
• Hysteroscopy
• Placement of an intrauterine device
• Dilation and curettage
• Cervicitis
• Prolonged labour, membrane rupture.
Pathophysiology
• Most cases of endometritis result from childbirth. Specifically,
the rupture of the amniotic sac allows translocation of normal
bacterial flora from the cervix and vagina to the usually aseptic
uterus. This bacteria is more likely to colonize uterine tissue
that has been devitalized, bleeding, or otherwise damaged .
This bacteria can invade the endometrium-, myometrium-, and
perimetrium, causing inflammation and infection.
SYMPTOMS OF ENDOMETRITIS
• Pelvic or abdominal pain
• Vaginal bleeding
• Un usual discharge
• Fever or chills
• Constipation
• foul smelling and purulent lochia
Contd..
• Redness
• Swelling
• Tachycardia
DIAGNOSIS
• History taking
• Physical examination
• Investigation: culture from the cervix for chlamydia, gonorrhea and
other organism.
• Endometrial biopsy.
• Ultra sound
• Laparoscopy
PREVENTION
• early diagnosis and complete treatment of sexually transmitted
infections.
• Practicing safe sex, such as using condom
• The risk of endometritis is reduced by the careful, sterile technique
used by providers when delivering a baby or performing an abortion,
IUCD placement or other gyneocological procedure.
POSSIBLE COMPLICATION
• Infertility
• Pelvic peritonitis
• Pelvic or uterine abscess formation
• Septicemia
• Septic shock
TREATMENT
• Keep patient in bed rest
• Give broad-spectrum antibiotics eg :ampicillin until the report of high
vaginal swap has waited.
• Modify the treatment according to the sensitivity of the organisms
found.
• Pyometra is present ,drainge of pus by simple dilation should be done
first.
• Oestrogen supplements ethinyloestradiol vaginal cream is helpful.
CONTD..
• In unresponsive cases or with recurrent attacks, hysterectomy should
be done.
• Dexocycline 100mg every 12 hour+metronidazole 5oomg every 12
hour.doxycylinic is not contraindicated in breastfeeding mother if it is
use if for less than three week.
• Levofloxacin 5oomg every 24 hour+metronidazole 5oomg every 8
hours levo floxacin should be avoided in breastfeeding mothers.
CONTD..
• For patient with moderate to severe endometritis and or patient with
cesarean section intravenous antibiotics and admission are
recommended option are as follows.
gentamicin 1.5mg\kg iv every 8 hour or 5mg\kg iv every 24 hour and
clindamycin 900mg every 8 hour
Removing tissues: if there is any tissue left in the uterus after
childbirth or a miscarriage ,need to removed
Contd..
• Treating any abscesses: if an abscess from in the abdomen from the
infection, surgery or needle aspiration will be needed to remove the
infected fluid or pus.
• If the infection is sexually transmitted, a women sexual partner also
need to be treated.
This Photo by Unknown Author is licensed under CC BY-NC
REFERENCESS
• Subedi prasai durga text book of gynecocology nursing page no 8o-88
• Awasthi Sherpa mamata text book of midewifery nursinh part 3 page
no 9o-92
• Dutta dc text book of gynecology 2016 edition page no 78-82
• Subedi devi maya text book of midewifery and gynecology nursing
part 1 page no 286-287
• Awasthi Sherpa mamata text book of mide wifery gynocological
nursing page no 45-53
This Photo by Unknown Author is licensed under CC BY-NC-ND
