Endometritis

Overview Of Endometritis

Endometritis is an inflammatory condition of the endometrium, the inner lining of the uterus. It is most commonly caused by infections, particularly after childbirth, miscarriage, or gynecological procedures such as dilation and curettage (D&C) or intrauterine device (IUD) insertion. The condition can be acute or chronic and is often associated with pelvic inflammatory disease (PID). Symptoms of endometritis include fever, pelvic pain, abnormal vaginal discharge, and uterine tenderness. If left untreated, endometritis can lead to serious complications such as sepsis, infertility, or chronic pelvic pain. Early diagnosis and treatment with antibiotics are essential to prevent long-term consequences and improve outcomes.

Causes of Endometritis

• Endometritis is primarily caused by bacterial infections that ascend from the lower genital tract into the uterus. Common pathogens include *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, and anaerobic bacteria such as *Bacteroides* and *Peptostreptococcus*. The infection can occur after childbirth (postpartum endometritis), particularly following cesarean delivery, or after gynecological procedures such as D&C, hysteroscopy, or IUD insertion. Other risk factors include prolonged rupture of membranes, retained placental tissue, and poor hygiene practices. Chronic endometritis is often associated with persistent infections, such as tuberculosis or chlamydia, or with conditions like intrauterine adhesions or endometrial polyps. Immunocompromised individuals are at higher risk of developing severe or recurrent endometritis.

Risk Factors of Endometritis

• Several factors increase the risk of developing endometritis. Postpartum women, particularly those who have undergone cesarean delivery, are at higher risk due to the potential for bacterial contamination during surgery. Gynecological procedures, such as D&C, hysteroscopy, or IUD insertion, can introduce bacteria into the uterus. Prolonged rupture of membranes, retained placental tissue, or incomplete abortion are additional risk factors. A history of sexually transmitted infections, particularly chlamydia or gonorrhea, increases susceptibility. Immunocompromised individuals, such as those with HIV or on immunosuppressive therapy, are at higher risk of severe or recurrent infections. Poor hygiene practices and lack of access to healthcare can also contribute to the development of endometritis.

Prevention of Endometritis

• Preventing endometritis involves reducing the risk of infection during and after gynecological procedures or childbirth. Proper infection control measures, such as sterile techniques during cesarean delivery or D&C, are essential. Prophylactic antibiotics are often administered before cesarean sections or other high-risk procedures to reduce the risk of infection. Prompt removal of retained placental tissue or products of conception can prevent postpartum endometritis. Managing underlying conditions, such as STIs or immunocompromise, is important for reducing susceptibility. Education and access to healthcare services are key components of prevention efforts. Regular screening for STIs and early treatment of infections can also help prevent endometritis.

Prognosis of Endometritis

• The prognosis for endometritis depends on the timeliness of diagnosis and treatment. With prompt and appropriate antibiotic therapy, most patients experience significant improvement within 48–72 hours, and symptoms typically resolve completely within a week. However, untreated or inadequately treated endometritis can lead to serious complications, such as sepsis, pelvic abscesses, or infertility. Chronic endometritis may result in persistent symptoms or recurrent infections, particularly if underlying causes are not addressed. Long-term outcomes are improved with early diagnosis, adherence to treatment, and addressing risk factors such as STIs or retained tissue. Regular follow-up is essential to monitor for complications and ensure complete recovery.

Complications of Endometritis

• If left untreated, endometritis can lead to several severe complications. Acute endometritis can progress to sepsis, a life-threatening systemic infection requiring hospitalization and intravenous antibiotics. Pelvic abscesses or peritonitis may develop if the infection spreads beyond the uterus. Chronic endometritis can cause scarring or adhesions within the uterine cavity, leading to infertility or recurrent pregnancy loss. Postpartum endometritis can result in delayed recovery, prolonged hospitalization, or the need for surgical intervention. In severe cases, the infection can spread to the fallopian tubes or ovaries, causing pelvic inflammatory disease (PID). Prompt treatment and follow-up are essential to prevent these complications and ensure the health of the patient.

Related Diseases of Endometritis

• Endometritis is closely associated with several other reproductive and systemic conditions. Pelvic inflammatory disease (PID) often coexists with endometritis and can lead to chronic pelvic pain or infertility. Postpartum infections, such as mastitis or wound infections, may occur concurrently with postpartum endometritis. Chronic endometritis is linked to conditions like intrauterine adhesions (Asherman’s syndrome) or endometrial polyps. Sexually transmitted infections, such as chlamydia or gonorrhea, are common causes of endometritis and require comprehensive management. Other infections, such as tuberculosis or fungal infections, can cause chronic endometritis in immunocompromised individuals. Understanding these related diseases is essential for accurate diagnosis and effective treatment.

Treatment of Endometritis

The treatment of endometritis involves antibiotic therapy to eradicate the causative pathogens and reduce inflammation. For acute endometritis, broad-spectrum antibiotics such as clindamycin plus gentamicin or ampicillin-sulbactam are commonly used. In cases of chronic endometritis, treatment may include doxycycline or metronidazole, depending on the identified pathogen. Supportive care, including pain management with analgesics and hydration, is important. In cases of retained placental tissue or abscesses, surgical intervention may be necessary. Sexual partners should be tested and treated if the infection is linked to an STI. Follow-up is essential to ensure resolution of symptoms and address any complications. Preventive measures, such as proper hygiene and infection control during procedures, are key to reducing the risk of endometritis.