Endometritis - inflammatory process in an inside mucous layer of a uterus – endometrium. It is often combined with an inflammation of a muscular layer of a uterus – endomiometrit. Endometrium is an internal functional cover of the uterus changing the structure throughout a menstrual cycle. Each cycle he grows up and ripens anew, preparing for an attachment of the impregnated ovum, and is torn away if pregnancy does not occur. Normal the uterus cavity covered by endometrium is reliably protected from penetration of an infection. But under certain conditions infectious activators easily get into a uterus and cause inflammatory reaction of its inside layer – an endometritis.
Endometritis - inflammatory process in an inside mucous layer of a uterus – endometrium. It is often combined with an inflammation of a muscular layer of a uterus – endomiometrit. Endometrium is an internal functional cover of the uterus changing the structure throughout a menstrual cycle. Each cycle he grows up and ripens anew, preparing for an attachment of the impregnated ovum, and is torn away if pregnancy does not occur. Normal the uterus cavity covered by endometrium is reliably protected from penetration of an infection. But under certain conditions infectious activators easily get into a uterus and cause inflammatory reaction of its inside layer – an endometritis. On character of a current allocate a sharp and chronic form of an endometritis.
The beginning of a sharp endometritis is often preceded by childbirth, abortion or miniabortion, a diagnostic scraping of a cavity of a uterus, hysteroscopy and other intrauterine manipulations. Incomplete removal of the remains of fetal egg, a placenta, a congestion of liquid blood and clots favor to development of an infection and sharp inflammatory process of an internal surface of a uterus. The most widespread display of a postnatal infection is the postnatal endometritis. It meets in 4%-20% of cases after a natural rodorazresheniye and in 40% - after operation of Cesarean section. It is connected with hormonal and immune reorganization in the pregnant woman's organism, decrease in the general immunity and resistance to infections.
The endometritis can be caused by various activators: bacteria, viruses, fungi, parasites, the mixed flora. Depending on the nature of an origin distinguish specific endometritises and nonspecific. Carry to specific infectious (virus, chlamydial, bacterial, protozoan, fungal) and parasitic endometritises. Them such activators as viruses of simple herpes, cytomegaloviruses, hlamidiya, mikobakteriya of tuberculosis, toxoplasma, a mycoplasma, Candida can cause, radiant fungi, gonokokk etc.
In development of an endometritis the condition of the immune, endocrine, nervous systems which are quite often burdening the course of a disease matters. At the nonspecific nature of an endometritis pathogenic flora in a uterus does not come to light. The nonspecific form of an endometritis can be caused by a bacterial vaginosis, HIV infection, existence of an intrauterine spiral, reception of hormonal contraceptives.
The chronic form of an endometritis often is a consequence of the undertreated sharp endometritis which arose after the delivery, abortion, intrauterine manipulations owing to existence of foreign matters of a uterus. In 80-90% of cases the chronic endometritis occurs among women of the reproductive period and tends to growth that is explained by prevalence of intrauterine contraception, increase in number of abortions, intrauterine diagnostic and medical procedures. The chronic endometritis costs among the most frequent reasons of infertility, abortions, unfortunate attempts of extracorporal fertilization, the complicated pregnancies, childbirth and the postnatal period.
For identification of the infectious agent at chronic endometritises immunocytochemistry diagnostics is used . The chronic form of an endometritis often has the erased clinical current without the expressed symptoms of a microbic infection. The thickening of a mucous uterus, a serous raid, gemorragiya, the fibrous solderings leading to violation of normal functioning of endometrium is noted.
Symptoms of a sharp endometritis
The sharp endometritis usually develops in 3-4 days after infection and is shown by temperature increase, pains in the bottom of a stomach, allocations from a genital tract with an unpleasant smell, a painful urination, increase of pulse, a fever. Sharp endometritises at the patients having intrauterine spirals have especially heavy and prompt current. Therefore the first symptoms of a sharp endometritis are a reason for immediate passing of consultation of the gynecologist.
At gynecologic inspection moderately increased and painful uterus, sanious or serous and purulent allocations is defined. The sharp stage lasts from a week to ten days and at effective therapy comes to an end with treatment, otherwise – transition to a chronic endometritis.
Symptoms of a chronic endometritis
Weight of a course of a chronic endometritis is caused by depth and duration of existence of structural changes of endometrium. As the main displays of a chronic endometritis serve violations of a menstrual cycle (poor or plentiful monthly), uterine bleedings, pathological serous and purulent or bloody allocations, the aching pains in the lower departments of a stomach, painful sexual intercourse. At a two-handled gynecologic research insignificant consolidation and increase in a uterus in sizes comes to light.
Structural changes of endometrium at a chronic endometritis can cause education and growth of polyps and cysts. The chronic endometritis in 10% of cases is the reason of infertility, in 60% - pregnancy not incubation. The muscular layer of a uterus also is quite often involved in inflammatory process – arises mioendometrit.
Risk of developing of an endometritis
In developing of an endometritis a special role is played by decrease in the barrier mechanisms of protection interfering penetration of an infection into internal genitals. It can be caused by the following reasons:
- patrimonial injuries of mother
Ruptures of a crotch, vagina, uterus neck in labor promote penetration of an infection into a genital tract and its ascension into a uterus cavity.
- the mechanical, chemical, thermal factors injuring a mucous membrane of a vagina
Violation of hygiene of genitals, frequent syringings, application of vaginal spermitsidny means etc. lead to change of normal microflora of a vagina and its protective properties.
- periods, childbirth, abortions
Release of blood leads to washing away of a secret of the tservikalny channel, alkalization of acidic environment of a vagina and decrease in its bactericidal properties. In these conditions pathogenic microorganisms freely get from the external environment and actively breed on the wound surface of a uterus.
- intrauterine contraceptives
Long time the intrauterine spirals which are in a cavity of a uterus become the potential source of an inflammation promoting penetration of an infection in the ascending way on threads of Naval Forces. If there was an endometritis, then removal of Naval Forces is necessary.
- use of vaginal tampons
Absorbing bloody allocations, tampons are the optimum environment for development of an infection. It is necessary to change tampons each 4-6 hours, not to use them at night, to or after periods, in hot climate. Violation of the rules of use of tampons can lead to development of a syndrome of toxic shock.
These factors it weaken an organism and do it subject to risk of infection.
Diagnosis of an endometritis
Diagnosis of a sharp endometritis is based on collecting the anamnesis of a disease, complaints of the patient, symptoms, gynecologic survey, clinical blood test and a bakterioskopichesky research of dabs. Women with a sharp form of an endometritis are treated permanently since there is a potential danger of development of heavy septic complications (a parametritis, a pelvioperitonit, peritonitis).
At diagnostics of a chronic form of an endometritis, except clarification of clinical symptoms and the anamnesis of a disease, the special role belongs to the scraping of a mucous membrane of a uterus which is carried out with the diagnostic purpose. The histologic research of the changed endometrium allows to confirm the diagnosis of a chronic endometritis. Important diagnostic methods are ultrasonic (ultrasonography) and endoscopic (hysteroscopy) researches, structural changes of endometrium allowing to reveal.
Treatment of a sharp endometritis
In a sharp phase of an endometritis treatment in a hospital with observance of a bed rest, mental and physical rest, a digestible full-fledged diet, drinking mode is shown to patients. The basis of medicinal treatment of a sharp endometritis is made by antibacterial therapy taking into account sensitivity of the activator (amoxicillin, ampicillin, , gentamycin, , lincomycin and ). At the mixed microbic flora the combination of several antibiotics is shown. In view of frequent connection of anaerobic activators the scheme of treatment of a sharp endometritis joins metronidazole.
For the purpose of removal of intoxication intravenous administration of salt and proteinaceous solutions to 2-2,5 l a day is shown. Inclusion in the scheme of treatment of a sharp endometritis of polyvitamins, antihistaminic medicines, immunomodulators, probiotics, antifungal means is expedient. With the soothing, anti-inflammatory and haemo static purpose apply cold on area of a stomach (2 hours – cold, 30 minutes – a break). When subsiding sharp symptoms physiotherapy, a girudoterapiya (medical bloodsuckers) is appointed.
Treatment of a chronic endometritis
In therapy of a chronic endometritis the modern gynecology applies the integrated approach including the antimicrobic, immunomodulatory, all-strengthening, physiotherapeutic treatment. Treatment is carried out step by step. The first step is elimination of infectious agents, then the course directed to endometrium restoration follows. Antibiotics of a broad spectrum of activity are usually applied (, doxycycline, etc.). The course of rehabilitation is constructed on a combination hormonal (an estradiol plus progesterone) and metabolic therapy (a haemo derivative of blood of calfs, inosine, ascorbic acid, vitamin E).
Medicines can be injected directly in mucous a uterus that creates their increased concentration directly in the center of an inflammation and provides high medical effect. Knocking over of uterine bleedings is carried out by purpose of hormones or solution of aminocaproic acid (intravenously or vnutrimatochno). The important place in treatment of a chronic endometritis is allocated to physical therapy: To UVCh, electrophoresis of copper, zinc, lidaza, iodine, pulse ultrasonic therapy, magnetotherapy. Physiotherapeutic treatment reduces inflammatory hypostasis of endometrium, intensifies blood circulation, stimulates immunological reactions. To patients with a chronic endometritis it is shown a kurortoterapiya (mud cure, balneotherapy).
Efficiency of treatment of a chronic endometritis is estimated by the following criteria:
- restoration of morphological structure of endometrium (by results of ultrasonography)
- restoration of a menstrual cycle.
- elimination of an infection
- disappearance of pathological symptoms (pains, bleedings)
- restoration of genital function
Complications and prevention of an endometritis
Endometrium is the important functional layer of a uterus which is responsible for providing a normal course of pregnancy. Inflammatory diseases of endometrium – endometritises - involve the complicated course of pregnancy: threat of an abortion, placentary insufficiency, postnatal bleedings. Therefore conducting pregnancy at the woman with the postponed endometritis has to be carried out with special attention.
As the remote consequences of the postponed endometritis serve adhesive processes in a uterus (intrauterine sinekhiya), sklerozirovany cavities of a uterus, the broken current of a menstrual cycle, polyps and cysts of endometrium. At an endometritis ovaries and pipes can be involved in inflammatory process, to develop peritonitis, solderings of intestines and bodies of a small pelvis (an adhesive disease). The adhesive disease is shown by pains and often leads to infertility.
To avoid developing of an endometritis, it is necessary not to allow abortions, to observe hygienic actions, especially during the menstrual period, to carry out prevention of a postnatal and postabortion infection, to use barrier contraception (condoms) for the purpose of prevention of infections sexually transmitted. Timely detection of asymptomatic infections and their treatment in most cases gives the favorable forecast concerning the subsequent pregnancy and childbirth.