Endometrial metroendometritis - Causes, Symptoms and Treatment .MF .
Endometritis - inflammatory disease of the lining of the uterus.Inflammation of the lining of the uterus can not but affect its muscular layer.In this case, the diagnosis metroendometritis , which is significantly more likely to be found on the first page rendered in the diagnosis and prognostic point of view, much worse for the patient.In order to understand the differences and similarities of these diagnoses must be a little touch of the uterine structure.
uterus consists of the cervix, uterine body and uterine tubes.The affected us topic structure of the body of the uterus is most important to consider.It consists of the endometrium (lining of the uterus - is its rejection and is accompanied by bleeding at mesyatsnyh, here is implanted fertilized egg), myometrium (its muscular shell, which is stretched during pregnancy, allowing the body to grow into many dozens of times) and perimetry (naruzhnayaya,serosa - is a continuation sheets of the peritoneum with the bladder).Despite the fact that the en
endometrium consists of two fundamentally different layers: the functional - the one who peels off at the end of every month and basal, which causes the formation of a new functional layer, and therefore causes the onset of the next menstruation.The functional layer is a layer of cells, shaped like cylinders (columnar epithelium), between which the glandular cells (produce the necessary mucus) and small terminal branches of spiral arteries in the set is located.Such a structure, a single-layer cells and the presence of a large number of small vessels, is quite fragile and susceptible to the adverse effects.
That damage above structures and leads to the possibility of getting infections and the occurrence of inflammation - endometritis.However, as mentioned above, is a close connection between all layers of the uterus with one another and the lack of protective barriers between them soon leads to a transition of endometritis in metroendometritis.
As mentioned above, the first and foremost cause of endometritis is damage to the mucous membrane of the uterus, leading to the development of the inflammatory process.We must also understand that a simple injury can lead to serious complications.Only the presence of lowered immunity, inflammation of the existing sluggish and poor hygiene in hospitals during manipulation may lead to inflammatory changes.The causes of damage are the first to be:
1. curettage of the uterus (the medical abortion curettage for bleeding and suspected oncology)
2. Sounding the uterus
3. Hysterosalpingography (uterus and fallopian tubes study, often with the aim of "blowing"in the treatment of infertility)
4. Hysteroscopy (endoscopic study of the uterine cavity)
5. Statement of intrauterine contraceptive
6. Sloppy douching
special place occupy postpartum endometritis, which are often found even in well-developed countries, which is primarily due to a significant decreaseand the restructuring of the immune system of the woman.Typically, the process is quite fast extends to the muscular layer and is a serious complication of the postpartum period.
polyetiology Endometritis disease - is caused by a group of agents, with the possible predominance of one.The most common pathogens are:
1. Group B Streptococcal
2. E. coli
3. Klebsiella Enterobacter
8. diphtheritic rod
9. tubercle bacilli
additionaddition, pathogens and viruses can serve as well as protozoa.
Causes of chronic endometritis
development of chronic endometritis due to inadequate treatment of acute or with undiagnosed process, in which case the infection for a long time in the tissues there.The causative agent can be all of the above.
Symptoms of endometritis
symptoms of endometriosis are sometimes not clearly marked, and a woman, unfortunately does not pay attention to them, which leads eventually to a more severe inflammation, not only mucosal but also the muscle layer of the uterus, requiring hospitalization and in-patient treatment.Therefore, a minimum knowledge of signs of endometritis and its causes, timely treatment to the doctor with these symptoms may prevent its transition to metroendometritis and allow doctors to dramatically improve the quality of life of their patients.
endometritis can be acute or chronic.If the treatment and diagnosis of acute endometritis usually presents no great difficulties, chronization process causes many difficulties in diagnosis and treatment.This is another reason that should immediately consult your doctor at the first symptoms of endometritis.
Symptoms of acute endometritis
most often occurs endometritis after abortion.The obvious fact is that criminal abortion mostly leads to such complications due to the almost complete non-sanitary norms.The disease begins with:
1. increase in body temperature to 38-39 ° C;
2. appearance of serous, serous-purulent and bloody discharges from the genital tract - a particularly important symptom in combination with history and general malaise, which allows us to differentiate endometritis from inflammatory lesions of the lower genital tract (bacterial vaginosis, coleitis et al.);
3. the appearance of pain in the abdomen radiating to the sacrum
4. general malaise.
In such a situation it is not necessary to wait until everything goes by itself and engage in self - endometritis is an inflammatory disease, and any inflammatory disease tends to spread far from the location of the primary tumor.Any self in this situation, postponing the visit to the obstetrician-gynecologist entails an inevitable increase in the risk of severe septic complications requiring prolonged hospital treatment, the result of which may well be an amputation of the uterus and the spread of infection - sepsis, with further fatalities.Therefore, the appearance of the first symptoms, a woman who had recently given birth, underwent surgery abortion, or any invasive diagnostic procedure should immediately consult a doctor and undergo a detailed examination.
Figure: pink - normal tissue;the rest is inflammatory changes
should be clarified that an endometritis can only say that when there is a background to this - in the past there were some other processes, affecting the integrity of the lining of the uterus.In the absence of such talk about the appearance of atypical endometrial secretions, pain or any other symptoms incompetent.
Symptoms of chronic endometritis
for chronic endometritis is difficult to identify the symptoms that would be different from the acute form.The symptomatology is, in this case, "oiled".The characteristic symptoms of chronic endometritis include:
1. Always keep the temperature for a long time.
2. Irregular uterine bleeding.Intermenstrual bleeding associated with increased vascular permeability of the endometrium during ovulation.Such a change of vessels observed in healthy women, but blood cells can not be seen in the secretions.By reasons for uterine bleeding, include reduction in uterine activity and violation of platelet aggregation.
3. The presence of permanent discharge from the external genital tract, often putrid nature.
4. Pain during defecation.
Chronic endometritis does not prevent conception, which occurs in the presence of ovulation.In conjunction with the accompanying violations of ovarian function, or other genital diseases causing chronic endometritis disorder of reproductive function - infertility and spontaneous abortions, including the usual.
When to see a doctor should be detailed to tell him all your medical history and all the symptoms that have led to it, because at this stage it becomes possible to assume presence at the patient of endometritis.In addition to anamnesis to your doctor must:
1. punish you with a gynecological examination in mirrors and palpation of the uterus - usually, the body increased in size, sensitive to touch;during the examination, the doctor will assess the nature of the discharge: the color, smell, consistency, amount;
2. take swabs - thanks to just take smears detected most of all agents of endometritis;take the material for culture - so you can explore the nature of the causative agent in more detail, grow it in a special nutrient medium, as well as to determine the degree of its response to a particular medicinal product;
3. take your blood for clinical and biochemical analysis (usually in the clinical analysis of blood will be a sufficient number of indicators to confirm the diagnosis - in the blood reveal leukocytosis, leukocyte formula shift to the left, accelerated ESR.);
4. do ultrasound of the uterus as possible (if you go with the already "developed" metroendometritis study could put some hospitals).The main ultrasonographic evidence of endometritis are: thickening of the lining of the uterus, blood clots and possibly pus (in cases complicated by blood-and pyometra), remnants of placental tissue, changes in echogenicity of the myometrium tissue metroendometritis.Often the inflammatory process affects the fallopian tubes and ovaries, which is also clearly visible on ultrasound.In chronic endometritis apart unevenly thickened endometrium, myometrium echogenicity with modified spikes can also be detected in the uterine cavity, which, in turn, can be a real cause of infertility.
diagnosis of chronic endometritis can be difficult, because the symptoms are similar to many diseases of female genital sphere.In this case, the constant is indicative Aftercrops same flora as well as indolent permanent inflammation.
treatment of endometritis
In the case of early diagnosis of endometritis may outpatient treatment, but under constant supervision of an obstetrician gynecologist.Typically, the treatment will consist of a combination of receiving and antipyretic antimicrobials.
Treatment of acute endometritis
Unfortunately, the vast majority of women go to the doctor rather late, leading to hospitalization and long-term treatment.In this case, you should study in detail the condition of the patient and the prevalence of the process, the reasons for it caused.The most common treatment starts with:
1. intravenous antibiotic therapy: cephalosporins in combination with metragilom and intramuscular gentamicin.The treatment can last from 5 to 10 days, depending on the need (often replaced aminoglycosides cephalosporins);
2. if "residues" in the uterus - the fruit of incomplete abortion, placental remnants after childbirth and caesarean section, shown scraping the uterine cavity after the infusion (intravenous drip) antibiotic therapy;
3. the use of vitamin and immunomodulators;
4. use of physical therapy.
Treatment of chronic endometritis
Treatment of chronic endometritis is based on the impact on the particular pathogen.To do this, again, it is absolutely necessary to take swabs for culture and susceptibility to antibiotics.Used as an antibacterial treatment regimen (as in acute endometritis), and antiviral drugs.
high therapeutic effect achieved by administration of drugs, including antibiotics directly to the uterine lining.The method provides a high concentration of drug in the hearth of chronic inflammation.
In addition to this, be sure to:
1. adhesiotomy surgically (preferably hysteroscopy)
2. hormonal therapy, most oral contraceptives, women who want to become pregnant in the future.
Physical therapy is widely used in the treatment of both acute and chronic endometritis in the phase when the first passed the most difficult period, and offset by a woman.Always in the hospital.For physiotherapy methods include: lower intensity therapy UHF (ultrahigh-frequency electromagnetic field exposure) with a wavelength of 1-10 m;infrared laser, etc.First of all it allows you to achieve: to improve the outflow of fluid and pus accumulated in the cavity of the uterus and enhances mestnoreparativnyh functions.
occupies a special place postpartum endometritis as a frequent and serious complication of postpartum process.As a rule, it is inseparable from endometritis, is acute and makes itself known quite early.
The main reasons are the remnants of placental tissue and infection due to non-compliance with health standards.
inpatient treatment.It lies in the massive antibiotic therapy, and calming process, remove all debris from the uterus.Unfortunately, not rarely complications leading to septic complications and in this case may be unfavorable prognosis - surgery (amputation of uterus may be needed).
In the case of breastfeeding - exclude breastfeeding at the time of antibiotic therapy and for a week or two after that.
necessarily strictly dieting hospital is not required.Enough: limiting fatty foods, drinking large kolichetsvo liquids consumption of fruit.In the case of hospital treatment necessarily subject to bed rest, diet and trudnousvoyaemoy except fatty food.
Typically, acute endometritis when time begun treatment does not require any special rehabilitation.After the treatment you need some time to be under a doctor's supervision.Perhaps the use of physiotherapy treatments: radon, hydrogen sulfide and air baths, under the supervision of a physiotherapist doctor.
Complications of endometritis
The most severe complications of endometritis include the spread of infection: hematogenically - through the blood;limfagenno - lymph;by upward - through the fallopian tubes and downward - the cervix, vagina ways.This leads to the "blood poisoning" - sepsis.Other complications include:
- chronic and outcome in chronic endometritis;
- formation of pyometra - a collection of pus in the uterus, due to occlusion (obstruction of the cervix and the inability to get out of pus);
- process connection of the fallopian tubes and appendages - oophoritis and salpingitis;
- pelvioperitonit - as a result of contact with the pus into the pelvic cavity.
By late complications that arise when inadequate treatment may include:
- menstrual disorders;
- persistent pain in the lower abdomen.
This list does not exhaust the complications as inflammation may be the cause of any pathology that may emerge later.Therefore, early treatment and adequate treatment play an important role in the prevention of serious complications.
Folk remedies for the treatment of endometritis
sure you must touch the craze of the population self-folk remedies.Endometritis - an inflammatory disease, which can lead to very serious consequences.His treatment - the lot of qualified obstetricians.Treatment should be carried out with all the latest tools available to achieve the maximum effect in a short time.We mentioned earlier that endometritis and metroendometritis very common in the postpartum period.