From the Guidelines
Endometritis is a clinical syndrome resulting from the ascending spread of microorganisms from the vagina and endocervix to the endometrium, fallopian tubes, and/or contiguous structures, typically presenting with lower abdominal pain and requiring the presence of specific clinical criteria for diagnosis 1.
Definition and Causes
Endometritis is an inflammation of the inner lining of the uterus (endometrium) typically caused by bacterial infection. It can occur after childbirth, miscarriage, abortion, or gynecological procedures, with symptoms including pelvic pain, abnormal vaginal discharge, fever, and uterine tenderness. The condition is often associated with the ascending spread of microorganisms from the lower genital tract or introduction during procedures.
Risk Factors and Prevention
Risk factors for endometritis include prolonged labor, cesarean delivery, retained placental fragments, or immunosuppression. Prompt treatment is essential to prevent complications such as abscess formation, sepsis, or infertility.
Diagnosis and Treatment
Diagnosis of endometritis involves clinical evaluation and may require histologic examination to confirm the presence of endometrial lesions. Treatment usually involves broad-spectrum antibiotics such as a combination of clindamycin and gentamicin until the patient has been afebrile for 24-48 hours, followed by oral antibiotics to complete a 7-14 day course. For non-obstetric cases, doxycycline may be prescribed. Patients should complete the full antibiotic course even if symptoms improve quickly, rest adequately, and use pain relievers like ibuprofen for discomfort.
Key Considerations
- Prompt treatment is crucial to prevent complications and improve outcomes in patients with endometritis.
- The choice of antibiotic therapy should be based on the severity of the infection and the patient's individual needs.
- Patients should be closely monitored for signs of complications and adjusted treatment as necessary.
- Rest, adequate hydration, and pain management are also important components of care.
- It is essential to note that while endometriosis and endometritis are distinct conditions, they can sometimes be related, with endometriosis being a condition where endometrial-like tissue grows outside the uterus, leading to inflammation and other symptoms 1.
Given the potential for severe complications and the importance of prompt treatment, it is critical to prioritize the diagnosis and management of endometritis based on the most recent and highest-quality evidence available 1.
From the Research
Definition of Endometritis
- Endometritis is defined as an infection or inflammation of the endometrium 2
- It can be classified into two types: acute and chronic endometritis
Types of Endometritis
- Acute endometritis is the symptomatic acute inflammation of the endometrium, which upon examination with a microscope shows micro-abscess and neutrophil invasion in the superficial endometrium 2
- Chronic endometritis is a silent disease usually diagnosed on the workup of secondary amenorrhoea and infertility 2
- Postpartum endometritis is a common manifestation of acute endometritis, which occurs when vaginal organisms invade the endometrial cavity during labor and delivery 3, 4
Causes and Risk Factors
- Tuberculosis is an important cause of chronic endometritis, especially in developing nations 2
- The risk of postpartum endometritis is higher after cesarean birth compared to vaginal birth 3, 4
Treatment and Management
- Antibiotic treatment is warranted for postpartum endometritis 3, 4
- The combination of clindamycin and gentamicin is a commonly recommended regimen for the treatment of endometritis 3, 4
- Regimens with good activity against penicillin-resistant anaerobic bacteria are more effective than those with poor activity 3, 4
- Oral and intramuscular antibiotic treatment options may be considered in low-resource settings where intravenous antibiotics are unavailable 5