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Endometritis is an irritation or inflammation of the uterine lining (the endometrium).
Endometrium is penetrated by a diverse range of immunocompetent cells, including macrophages, natural killer cells, and T lymphocyte subsets, under normal settings. Throughout the menstrual cycle, the composition and density of endometrial immune capable cells changes. The tissue remodeling required to achieve endometrial receptivity is thought to be aided by such timed fluctuations in local leukocyte subpopulations.
Endometritis is an irritation or inflammation of the uterine lining (the endometrium). It usually happens after a woman has birth, although it can also happen to non-pregnant women. Inflammation of the endometrium can also affect the myometrium and, in rare occasions, the parametrium1.
Acute endometritis 3
Microabscess development and neutrophil invasion in the endometrial superficial epithelium, gland lumina, and uterine cavity characterise acute endometritis.
Compromised abortions, deliveries, medical instruments, and the preservation of placental remnants are the most common reasons for organism isolation.
During acute endometritis, histologically, there is neutrophilic infiltration of the endometrial tissue.
The characteristic high temperature and purulent vaginal discharge are evident in the clinical presentation.
Menstruation is abnormally heavy following acute endometritis. Staphylococci, Streptococci, and N.gonorrheae are the most common causes.
Chronic endometritis 3
Endometrial superficial edematous alteration, high stromal cell density, dissociated maturation between epithelium and stroma, and infiltration of endometrial stromal plasmacytes are histopathologic characteristics.
The presence of plasma cells in the stroma distinguishes this condition.
Lymphocytes, eosinophils, and even lymphoid follicles can be observed, but without plasma cells, a histologic diagnosis is impossible.
Neisseria gonorrheae, Streptococcus, Chlamydia, Tuberculosis, Mycoplasma, and other organisms are most common.
The following tests may be performed:
Features: endometrial hyperemia (focal or diffuse), hemorrhagic spots, dilated endometrial vessels, micropolyps, endometrial polyp
Treatments for endometritis3
For acute endometritis
Oral antibiotics for mild disease (doxycycline / metronidazole, levofloxacin / metronidazole or amoxicillin / clavulanate) antiobiotics (such as gentamicin or clindamycin) if more severe.
For chronic endometritis
The therapy for is pharmacological and is based on the administration of broad-spectrum antibiotics
Generally, the drug of choice is doxycycline, administered in doses of 100 mg every 12 hours for 14 days, or alternatively, the administration of cephalosporins, macrolides, or quinolones also considered.
Where antibiotic therapy fails and/or where the presence of endometritis persists, an endo‐ metrial culture with a relative antibiogram should be considered and an appropriate antibiotic treatment regimen must be prescribed.
According to the Centres for Disease Control guidelines, the therapies recommended are in case of positive for Gram-negative bacteria: Ciprofloxacin 500 mg twice a day for 10 days as first line therapy
For gram-positive bacteria: Amoxicillin+clavulanate 1 g twice a day for 8 days; Mycoplasma and U. urealyticum infections: Josamycin 1 g twice a day for 12 days; while, in case of persistence, minocycline 100 mg twice a day for 12 days.
For negative cultures: Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg orally twice a day for 14 days with metronidazole 500 mg orally twice a day for 14 days.
In case of persistence of signs of chronic endometritis at subsequent hysteroscopy, the protocol can be repeated up to three times. In the presence of confirmed tuberculous endometritis, the patient should be given a specific antibiotic therapy for tuberculosis (isoniazid, ethambutol, rifampicin, and pyrazinamide for 2 months, followed by isoniazid and rifampicin for another 4 months).
Endometritis caused by sexually transmitted infections can be prevented by
Dr Sarbani Mandal.,
MBBS (Hons.), MS (G&O), MRCOG 1. Senior Resident, Bhagajatin State General Hospital, Kolkata.