Endometritis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords: acute endometritis, chronic endometritis, postpartum endometritis, puerperal endometritis

Overview

Endometritis is classified histopathologically into two subtypes: acute endometritis and chronic endometritis (CE). Acute endometritis occurs following abortion, childbirth, menstruation, curettage, or IUD insertion. Symptoms of acute endometritis may include fever, pelvic pain, and vaginal discharge. On histopathology, many neutrophils are seen in the endometrial stroma in acute endometritis. Chronic endometritis may cause infertility. Chronic endometritis (CE) is mostly asymptomatic but may have vague symptoms. On histopathology, plasma cells are seen in the endometrial stroma in chronic endometritis (CE). Endometritis is mostly caused by infection and treated with antibiotics. Pyometra is a rare disorder with pus accumulation in the uterine cavity due to abnormal drainage of the uterus.

Historical Perspective

There is limited information on the historical perspective of endometritis.

Classification

Endometritis may be classified according to histopathology into two subtypes:[1]

Pyometra

Pathophysiology

Postpartum endometritis

Postpartum endometritis is caused by bacteria (vaginal microflora) ascending from the lower genital tract during labor.[9]

Artificial or spontaneous rupture of membranes may also happen without bacterial colonization.[9]

Chronic Endometritis

In the normal endometrium, B-cells are mostly seen in the basal layer.[10]

In chronic endometritis (CE):[11]

Histopathology

Histopathology 
Acute Endometritis Chronic Endometritis
The histopathologic findings in acute endometritis include:[1] The histopathologic findings in chronic endometritis (CE) include:[1][26]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries. Histopathologically, chronic granulomatous endometritis has caseating granuloma surrounded by infiltrates of lymphocytes which include endometrial stromal plasmacytes (ESPCs).[4]

Causes

Causes 
Postpartum Endometritis Chronic Endometritis
Postpartum endometritis is caused by bacteria ascending from the lower genital tract into the cervix during labor. These bacteria that are the vaginal microflora include:[9] The most common cause of chronic endometritis (CE) is an infection with microorganisms, including:[27][28][29]

Acute endometritis may be caused by Chlamydia trachomatis and Neisseria gonorrhea.[30]

The rate of infections with Chlamydia trachomatis (2%–7%) and Neisseria gonorrhea (0%–8%) in chronic endometritis (CE) are very low. [27][31][32]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries.[4]

The association of viral infections as causes of chronic endometritis (CE) is still unclear.[11]

Differentiating Endometritis from other Diseases

Puerperal endometritis must be differentiated from:[3]

To view more differential diagnosis, click here.

Epidemiology

Puerperal Endometritis

The prevalence of endometritis is 1% to 2% of births and 27% of cesarean births.[33][34]

Chronic Endometritis

The prevalence of chronic endometritis (CE) is about 10% to 11% on biopsies performed from hysterectomies of patients with gynecologic conditions.[20][32]

In a study, the prevalence of CE has been reported to be 15% in infertile women with in vitro fertilization (IVF) and 42% in women with recurrent implantation failure (RIF).[35]

The prevalence of CE has been reported to be 57.8% in women with three or more recurrent pregnancy losses (RPLs).[36]

In one study, the prevalence of CE has been reported to be 14% and 27% in patients with RIF or RPL, respectively.[37]

Risk Factors

Risk Factors 
Puerperal Endometritis Chronic Endometritis
Risk factors associated with puerperal endometritis include:[33][34][38][9] Risk factors that have been reported to be associated with chronic endometritis (CE) include:[20][39][40][41][42][43][44][45][46][47]

Screening

Routine antepartum screening for GBS infection and treatment of genital tract infections are important in preventing puerperal genital tract infection.[48]

There is insufficient evidence to recommend routine screening for chronic endometritis (CE). However, it has been suggested that hysteroscopy may have the potential to be a screening tool for CE.[11]

Natural History, Complications, and Prognosis

Natural History

Studies have suggested that patients with chronic endometritis (CE) may develop:[49][35][36]

Complications

Complications 
Puerperal Endometritis Chronic Endometritis
Complications of puerperal endometritis after cesarean birth may include:[34][50] Common complications of chronic endometritis (CE) include:[51][52][53][49][54]

Prognosis

A study showed that after antibiotic treatment of patients with CE and recurrent pregnancy losses (RPLs), the pre-pregnancy live birth rate increased from 7% (before treatment) to 56% (after treatment).[52]

Another study showed that after antibiotic treatment of patients with CE, the implantation rate and pregnancy rate increased from 4.9% and 7.4% (before treatment) to 18.6% and 29.3% (after treatment), respectively.[55]

Diagnosis

Diagnostic Study of Choice

The histological finding of acute endometritis includes a large number of neutrophils in the endometrial stroma.[56]

The diagnosis of chronic endometritis (CE) is made with endometrial biopsy and the histological diagnostic criterion is plasma cells in the endometrial stroma.[20][57]

History and Symptoms

History and Symptoms 
Acute Endometritis Chronic Endometritis
Symptoms of acute endometritis may include:[58][59] Chronic endometritis (CE) is mostly asymptomatic but may have vague symptoms including:[58][60][61]

Physical Examination

Clinical findings found on physical examination in puerperal endometritis may include:[59]

Laboratory Findings

Laboratory tests in puerperal endometritis include:[48][3]

There is insufficient evidence that suggests obtaining endometrial or cervical cultures in puerperal endometritis due to contamination while obtaining an endometrial culture.[62][63]

Laboratory findings in acute endometritis may include:[64]

Staining used in histological detection of chronic endometritis (CE) include:

Electrocardiogram

There are no ECG findings associated with endometritis.

X-ray

There are no x-ray findings associated with endometritis. However, a chest x-ray should be performed if there is suspicion of a respiratory disorder.[3]

Echocardiography or Ultrasound

There are no echocardiography findings associated with endometritis.

Ultrasound is usually not helpful in the diagnosis of endometritis. However, an ultrasound may be helpful to rule out other disorders in postpartum patients that are nonresponsive to therapy.[67] Ultrasound and CT findings in postpartum endometritis may include:[67][68][69][70][71]

CT scan

Ultrasound and CT findings in postpartum endometritis may include:[67][68][69][70][71]

Compared to ultrasound, CT scan is more helpful in identifying the inflammation of the soft tissues and pelvic abscesses.[72]

MRI

There are no specific MRI findings associated with endometritis. However, MRI may be helpful if there is suspicion of septic pelvic thrombophlebitis.[62]

Other Imaging Findings

Fluid hysteroscopy is helpful in diagnosing chronic endometritis (CE) and the findings include:[18][27]

Treatment

Medical Therapy

Histopathology 
Postpartum Endometritis Chronic Endometritis
Patients with postpartum endometritis are recommended to be treated with either:[73] Patients with chronic endometritis (CE) are treated with:

Surgery

Surgery may be indicated if there is drainable fluid collection due to infection.[62]

Primary Prevention

The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) recommend antimicrobial prophylaxis 60 minutes prior to incision of cesarean birth.[74][75][76]

A Conchrane study showed that antimicrobial prophylaxis decreases uterine and wound infections.[75]

Some of the measures that should be considered in order to reduce genital tract infections include:[48][75][77][78]

Secondary Prevention

There are no established measures for the secondary prevention of endometritis.

References

  1. ↑ 1.0 1.1 1.2 Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA; et al. (1990). "Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis". Am J Surg Pathol. 14 (2): 167–75. doi:10.1097/00000478-199002000-00008. PMID 2137304.
  2. ↑ Hellweg, G (2010). Atlas of endometrial histopathology. Heidelberg: Springer. ISBN 978-3-642-01541-0. OCLC 663096526.
  3. ↑ 3.0 3.1 3.2 3.3 Cunningham, F (2010). Williams obstetrics. New York: McGraw-Hill Medical. ISBN 978-0-07-149701-5. OCLC 495191519.
  4. ↑ 4.0 4.1 4.2 Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S; et al. (2008). "Association of tuberculous endometritis with infertility and other gynecological complaints of women in India". J Clin Microbiol. 46 (12): 4068–70. doi:10.1128/JCM.01162-08. PMC 2593260. PMID 18842939.
  5. ↑ Muram D, Drouin P, Thompson FE, Oxorn H (1981). "Pyometra". Can Med Assoc J. 125 (6): 589–92. PMC 1862642. PMID 7284938.
  6. ↑ Yamada T, Ando N, Shibata N, Suitou M, Takagi H, Matsunami K; et al. (2015). "Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin". Case Rep Surg. 2015: 548481. doi:10.1155/2015/548481. PMC 4299690. PMID 25628913.
  7. ↑ 7.0 7.1 7.2 7.3 Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN (2006). "Spontaneous perforation of pyometra". Infect Dis Obstet Gynecol. 2006: 26786. doi:10.1155/IDOG/2006/26786. PMC 1581463. PMID 17093350.
  8. ↑ Shapey IM, Nasser T, Dickens P, Haldar M, Solkar MH (2012). "Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum". Ann R Coll Surg Engl. 94 (8): e246–8. doi:10.1308/003588412X13373405387410. PMC 3954306. PMID 23131215.
  9. ↑ 9.0 9.1 9.2 9.3 Faro S (2005). "Postpartum endometritis". Clin Perinatol. 32 (3): 803–14. doi:10.1016/j.clp.2005.04.005. PMID 16085035.
  10. ↑ Yeaman GR, Guyre PM, Fanger MW, Collins JE, White HD, Rathbun W; et al. (1997). "Unique CD8+ T cell-rich lymphoid aggregates in human uterine endometrium". J Leukoc Biol. 61 (4): 427–35. PMID 9103229.
  11. ↑ 11.0 11.1 11.2 Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T (2018). "Endometritis: new time, new concepts". Fertil Steril. 110 (3): 344–350. doi:10.1016/j.fertnstert.2018.04.012. PMID 29960704.
  12. ↑ Tabibzadeh SS, Bettica A, Gerber MA (1986). "Variable expression of Ia antigens in human endometrium and in chronic endometritis". Am J Clin Pathol. 86 (2): 153–60. doi:10.1093/ajcp/86.2.153. PMID 3461701.
  13. ↑ 13.0 13.1 Kitaya K, Yasuo T (2010). "Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis". Mod Pathol. 23 (8): 1136–46. doi:10.1038/modpathol.2010.98. PMID 20495539.
  14. ↑ Matteo M, Cicinelli E, Greco P, Massenzio F, Baldini D, Falagario T; et al. (2009). "Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis". Am J Reprod Immunol. 61 (5): 322–9. doi:10.1111/j.1600-0897.2009.00698.x. PMID 19341383.
  15. ↑ 15.0 15.1 Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C; et al. (2014). "Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis". Fertil Steril. 101 (1): 242–7. doi:10.1016/j.fertnstert.2013.09.041. PMID 24314919.
  16. ↑ Salama SA, Kamel MW, Diaz-Arrastia CR, Xu X, Veenstra TD, Salih S; et al. (2009). "Effect of tumor necrosis factor-alpha on estrogen metabolism and endometrial cells: potential physiological and pathological relevance". J Clin Endocrinol Metab. 94 (1): 285–93. doi:10.1210/jc.2008-1389. PMC 2630861. PMID 18957495.
  17. ↑ Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y (2012). "Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps". Hum Reprod. 27 (12): 3474–80. doi:10.1093/humrep/des323. PMID 22951914.
  18. ↑ 18.0 18.1 Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N (2005). "Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis". Hum Reprod. 20 (5): 1386–9. doi:10.1093/humrep/deh779. PMID 15734762.
  19. ↑ Kitaya K, Tada Y, Hayashi T, Taguchi S, Funabiki M, Nakamura Y (2014). "Comprehensive endometrial immunoglobulin subclass analysis in infertile women suffering from repeated implantation failure with or without chronic endometritis". Am J Reprod Immunol. 72 (4): 386–91. doi:10.1111/aji.12277. PMID 24898900.
  20. ↑ 20.0 20.1 20.2 20.3 20.4 Kitaya K, Yasuo T (2011). "Immunohistochemistrical and clinicopathological characterization of chronic endometritis". Am J Reprod Immunol. 66 (5): 410–5. doi:10.1111/j.1600-0897.2011.01051.x. PMID 21749546.
  21. ↑ Kushnir VA, Solouki S, Sarig-Meth T, Vega MG, Albertini DF, Darmon SK; et al. (2016). "Systemic Inflammation and Autoimmunity in Women with Chronic Endometritis". Am J Reprod Immunol. 75 (6): 672–7. doi:10.1111/aji.12508. PMID 26952510.
  22. ↑ 22.0 22.1 Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA; et al. (2013). "Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis". Am J Reprod Immunol. 69 (5): 509–17. doi:10.1111/aji.12076. PMID 23351011.
  23. ↑ Mishra K, Wadhwa N, Guleria K, Agarwal S (2008). "ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis". J Obstet Gynaecol Res. 34 (3): 371–8. doi:10.1111/j.1447-0756.2007.00700.x. PMID 18686353.
  24. ↑ Pickartz H, Beckmann R, Fleige B, Düe W, Gerdes J, Stein H (1990). "Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria". Virchows Arch A Pathol Anat Histopathol. 417 (2): 163–71. doi:10.1007/BF02190535. PMID 2114696.
  25. ↑ 25.0 25.1 Wu D, Kimura F, Zheng L, Ishida M, Niwa Y, Hirata K; et al. (2017). "Chronic endometritis modifies decidualization in human endometrial stromal cells". Reprod Biol Endocrinol. 15 (1): 16. doi:10.1186/s12958-017-0233-x. PMC 5336610. PMID 28259137.
  26. ↑ Greenwood SM, Moran JJ (1981). "Chronic endometritis: morphologic and clinical observations". Obstet Gynecol. 58 (2): 176–84. PMID 7254729.
  27. ↑ 27.0 27.1 27.2 Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L; et al. (2008). "Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies". Fertil Steril. 89 (3): 677–84. doi:10.1016/j.fertnstert.2007.03.074. PMID 17531993.
  28. ↑ Cicinelli E, De Ziegler D, Nicoletti R, Tinelli R, Saliani N, Resta L; et al. (2009). "Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis". Gynecol Obstet Invest. 68 (2): 108–15. doi:10.1159/000223819. PMID 19521097.
  29. ↑ Kitaya K, Matsubayashi H, Takaya Y, Nishiyama R, Yamaguchi K, Takeuchi T; et al. (2017). "Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure". Am J Reprod Immunol. 78 (5). doi:10.1111/aji.12719. PMID 28608596.
  30. ↑ Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL; et al. (2011). "Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research". Pathol Res Pract. 207 (11): 680–5. doi:10.1016/j.prp.2011.08.007. PMC 3215901. PMID 21996319.
  31. ↑ Haggerty CL, Hillier SL, Bass DC, Ness RB, PID Evaluation and Clinical Health study investigators (2004). "Bacterial vaginosis and anaerobic bacteria are associated with endometritis". Clin Infect Dis. 39 (7): 990–5. doi:10.1086/423963. PMID 15472851.
  32. ↑ 32.0 32.1 Polisseni F, Bambirra EA, Camargos AF (2003). "Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients". Gynecol Obstet Invest. 55 (4): 205–10. doi:10.1159/000072075. PMID 12904693.
  33. ↑ 33.0 33.1 French LM, Smaill FM (2004). "Antibiotic regimens for endometritis after delivery". Cochrane Database Syst Rev (4): CD001067. doi:10.1002/14651858.CD001067.pub2. PMID 15495005.
  34. ↑ 34.0 34.1 34.2 Sweet, Richard (2009). Infectious diseases of the female genital tract. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0-7817-7815-2. OCLC 268792315.
  35. ↑ 35.0 35.1 Romero R, Espinoza J, Mazor M (2004). "Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization?". Fertil Steril. 82 (4): 799–804. doi:10.1016/j.fertnstert.2004.05.076. PMID 15482749.
  36. ↑ 36.0 36.1 Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z (2011). "The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion". Eur J Obstet Gynecol Reprod Biol. 155 (2): 217–20. doi:10.1016/j.ejogrb.2010.12.010. PMID 21232841.
  37. ↑ Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C (2016). "Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis". Fertil Steril. 105 (1): 106–10. doi:10.1016/j.fertnstert.2015.09.025. PMID 26456229.
  38. ↑ Belfort MA, Clark SL, Saade GR, Kleja K, Dildy GA, Van Veen TR; et al. (2010). "Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period". Am J Obstet Gynecol. 202 (1): 35.e1–7. doi:10.1016/j.ajog.2009.08.029. PMID 19889389.
  39. ↑ Moyer DL, Mishell DR, Bell J (1970). "Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD". Am J Obstet Gynecol. 106 (6): 799–809. doi:10.1016/0002-9378(70)90470-9. PMID 4984305.
  40. ↑ Smith M, Hagerty KA, Skipper B, Bocklage T (2010). "Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007". Int J Gynecol Pathol. 29 (1): 44–50. doi:10.1097/PGP.0b013e3181ae81bb. PMID 19952932.
  41. ↑ Chen YQ, Fang RL, Luo YN, Luo CQ (2016). "Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study". BMC Womens Health. 16 (1): 60. doi:10.1186/s12905-016-0341-3. PMC 5477816. PMID 27596852.
  42. ↑ Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC; et al. (2017). "Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link". Fertil Steril. 108 (2): 289–295.e1. doi:10.1016/j.fertnstert.2017.05.016. PMID 28624114.
  43. ↑ Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A; et al. (2014). "The association between endometriosis and chronic endometritis". PLoS One. 9 (2): e88354. doi:10.1371/journal.pone.0088354. PMC 3928198. PMID 24558386.
  44. ↑ Korn AP, Bolan G, Padian N, Ohm-Smith M, Schachter J, Landers DV (1995). "Plasma cell endometritis in women with symptomatic bacterial vaginosis". Obstet Gynecol. 85 (3): 387–90. doi:10.1016/0029-7844(94)00400-8. PMID 7862377.
  45. ↑ Peipert JF, Montagno AB, Cooper AS, Sung CJ (1997). "Bacterial vaginosis as a risk factor for upper genital tract infection". Am J Obstet Gynecol. 177 (5): 1184–7. doi:10.1016/s0002-9378(97)70038-3. PMID 9396917.
  46. ↑ Jindal UN, Verma S, Bala Y (2012). "Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis". Hum Reprod. 27 (5): 1368–74. doi:10.1093/humrep/des076. PMID 22419745.
  47. ↑ Degani S, Gonen R, de Vries K, Sharf M (1983). "Endometrial ossification associated with repeated abortions". Acta Obstet Gynecol Scand. 62 (3): 281–2. doi:10.3109/00016348309155810. PMID 6414236.
  48. ↑ 48.0 48.1 48.2 Maharaj D (2007). "Puerperal pyrexia: a review. Part I." Obstet Gynecol Surv. 62 (6): 393–9. doi:10.1097/01.ogx.0000265998.40912.5e. PMID 17511893.
  49. ↑ 49.0 49.1 Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T; et al. (2016). "Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications". Am J Reprod Immunol. 75 (1): 13–22. doi:10.1111/aji.12438. PMID 26478517.
  50. ↑ Soper DE (2012). "Early recognition of serious infections in obstetrics and gynecology". Clin Obstet Gynecol. 55 (4): 858–63. doi:10.1097/GRF.0b013e3182730f43. PMID 23090454.
  51. ↑ 51.0 51.1 Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA (2010). "Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization". Fertil Steril. 93 (2): 437–41. doi:10.1016/j.fertnstert.2008.12.131. PMID 19217098.
  52. ↑ 52.0 52.1 52.2 52.3 McQueen DB, Bernardi LA, Stephenson MD (2014). "Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise". Fertil Steril. 101 (4): 1026–30. doi:10.1016/j.fertnstert.2013.12.031. PMID 24462055.
  53. ↑ Kitaya K (2011). "Prevalence of chronic endometritis in recurrent miscarriages". Fertil Steril. 95 (3): 1156–8. doi:10.1016/j.fertnstert.2010.09.061. PMID 21030015.
  54. ↑ Ghidini A, Salafia CM (2005). "Histologic placental lesions in women with recurrent preterm delivery". Acta Obstet Gynecol Scand. 84 (6): 547–50. doi:10.1111/j.0001-6349.2005.00694.x. PMID 15901265.
  55. ↑ Yang R, Du X, Wang Y, Song X, Yang Y, Qiao J (2014). "The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients". Arch Gynecol Obstet. 289 (6): 1363–9. doi:10.1007/s00404-013-3131-2. PMID 24395012.
  56. ↑ Eckert LO, Hawes SE, Wölner-Hanssen PK, Kiviat NB, Wasserheit JN, Paavonen JA; et al. (2002). "Endometritis: the clinical-pathologic syndrome". Am J Obstet Gynecol. 186 (4): 690–5. doi:10.1067/mob.2002.121728. PMID 11967492.
  57. ↑ 57.0 57.1 Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC; et al. (2011). "The impact of chronic endometritis on reproductive outcome". Fertil Steril. 96 (6): 1451–6. doi:10.1016/j.fertnstert.2011.09.039. PMID 22019126.
  58. ↑ 58.0 58.1 Michels TC (1995). "Chronic endometritis". Am Fam Physician. 52 (1): 217–22. PMID 7604765.
  59. ↑ 59.0 59.1 King, Tekoa (2015). Varney's midwifery. Burlington, MA: Jones & Bartlett Learning. ISBN 978-1-284-02541-5. OCLC 855888968.
  60. ↑ Rotterdam H (1978). "Chronic endometritis. A clinicopathologic study". Pathol Annu. 13 Pt 2: 209–31. PMID 748840.
  61. ↑ Yörükoğlu K, Kuyucouğlu F (1998). "Chronic nonspecific endometritis". Gen Diagn Pathol. 143 (5–6): 287–90. PMID 9653909.
  62. ↑ 62.0 62.1 62.2 Karsnitz DB (2013). "Puerperal infections of the genital tract: a clinical review". J Midwifery Womens Health. 58 (6): 632–42. doi:10.1111/jmwh.12119. PMID 24406036.
  63. ↑ Maharaj D (2007). "Puerperal Pyrexia: a review. Part II". Obstet Gynecol Surv. 62 (6): 400–6. doi:10.1097/01.ogx.0000266063.84571.fb. PMID 17511894.
  64. ↑ Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune A; et al. (2019). "Review: Chronic endometritis and its effect on reproduction". J Obstet Gynaecol Res. 45 (5): 951–960. doi:10.1111/jog.13937. PMID 30843321.
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  66. ↑ McQueen DB, Perfetto CO, Hazard FK, Lathi RB (2015). "Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss". Fertil Steril. 104 (4): 927–931. doi:10.1016/j.fertnstert.2015.06.044. PMID 26207958.
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  72. ↑ Bennett GL, Slywotzky CM, Giovanniello G (2002). "Gynecologic causes of acute pelvic pain: spectrum of CT findings". Radiographics. 22 (4): 785–801. doi:10.1148/radiographics.22.4.g02jl18785. PMID 12110710.
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  77. ↑ Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J (2010). "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis". Am J Obstet Gynecol. 203 (3): 243.e1–8. doi:10.1016/j.ajog.2010.05.028. PMID 20598284.
  78. ↑ National Collaborating Centre for Primary Care (UK) (2006). "Postnatal Care: Routine Postnatal Care of Women and Their Babies". National Institute for Health and Clinical Excellence: Guidance. PMID 21834192.
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