Endometritis resident survival guide

Endometritis Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Postpartum endometritis:
Postpartum endometritis is caused by bacteria ascending from the lower genital tract into the cervix during labor. These bacterias that are the vaginal microflora include:

• Alpha hemolytic streptococci
• Corynebacterium
• Diphtheroids
• E.coli
• Enterobacter agglomerans, Enterobacter cloacae, Enterobacter aerogenes
• Fusobacterium necrophorum
• Klebsiella pneumoniae
• Lactobacillus crispatus, L casei, L jansei
• Mycoplasma genitalia, Mycoplasma hominis
• Nondescript streptococci
• Prevotella bivia, Prevotella melaninogenicus
• Staphylococcus epidermidis
• Ureaplasma urealyticum

Chronic endometritis:
Common cause of chronic endometritis (CE) is an infection with microorganisms, including:

• Bacteria:
  • Escherichia coli
  • Streptococcus species
  • Staphylococcus species
  • Enterococcus faecalis
  • Mycoplasma or ureaplasma species:
    • Mycoplasma genitalium
    • Mycoplasma hominis
    • Ureaplasma urealyticum
  • Proteus species
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Gardnerella vaginalis
  • Corynebacterium
• Yeasts:
  • Candida species
  • Saccharomyces cerevisiae

Acute endometritis:
Acute endometritis may be caused by Chlamydia trachomatis and Neisseria gonorrhea.

Risk factors associated with endometritis are

• Miscarriage or after childbirth, especially following a prolonged labor or a cesarean delivery.
• Medical procedures include:
  • Hysteroscopy
  • Placement of an intrauterine device (IUD)
  • Dilation and curettage (uterine scraping)

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Endometritis:

Abbreviations: BP: Blood pressure; RR=Respiratory rate; HR=Heart Rate, PROM= Premature rupture of membranes; AFV= Amniotic fluid volume

Pregnant woman comes with Endometritis

Take complete history

Record the vitals: ❑ Blood pressure ❑ Temperature ❑ Respiratory rate ❑ Heart rate

Ask the following questions about menstrual history : ❑ Age of menarche ❑ Last menstrual period ❑ Is the menstrual flow normal? How many pads she has to use in a day? ❑ Is there any foul smell or colour change? ❑ How many days does the menstruation stay? ❑ Contraceptive history for example oral contraceptives, intrauterine device

Ask the following questions : ❑ Do you have painful periods or menstrual cramps or excessive pain during menstruation? ❑ Have you experienced pain during sexual intercourse? ❑ Is there any pain in pelvis or abdomen? ❑ Have you experienced low back pain recently which is not due to mechanical problems? ❑ Have you noticed irregular bleeding? ❑ Have you felt abdominal pain on urination? ❑ Is there any urinary symptoms not specified as with cycle (frequency, dysuria, haematuria, presumed urinary tract infection)? ❑ Is there any menstrual haematuria? ❑ Have you had any pain on defecation which is not due to haemorrhoids or anal fissure? ❑ Is there any rectal bleeding not due to haemorrhoids or anal fissure? ❑ Is there any cyclical extrapelvic pain? ❑ Have you experienced postcoitalbleeding?

Look if the following symptoms are present : ❑ Fever,the grade of the fever is often indicative of the severity of the infection. ❑ Abdominal pain (commonly suprapubic in location) ❑ Foul-smelling and purulent lochia. ❑ Tachycardia ❑ Hypotension. ❑ Sepsis, diarrhoea, pain out of proportion in case of endometritis caused by Group A Streptococcus which may develop into toxic shock and necrotizing fasciitis.

Ask about previous obstetric history if she was previously pregnant : ❑ Ask about previous pregnancies including miscarriages and terminations. ❑ Length of gestation. ❑ Ask about mode of delivery. ❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

Perform the physical examination : ❑ Suprapubic and uterine tenderness are often present on abdominal and pelvic exams.

Do the laboratory tests: ❑ Complete blood count : A leukocytosis of 15000 to 30000 cells/microL is commonly seen. ❑ Cervical cultures taken before antibiotic administration can be helpful for appropriate antibiotic selection. ❑ Vaginal cultures are often contaminated and can mislead to inadequate antibiotic coverage. ❑ Blood cultures should be obtained if there is a high enough clinical suspicion for sepsis or bacteremia. ❑ Ultrasound can be used to rule out retained products of conception, infected hematoma, and uterine abscesses. Patients with endometritis, findings consist of a thickened, heterogeneous endometrium, intracavitary fluid, and foci of air ❑ Computed tomography can show the same positive findings as ultrasound plus possible perimetrium or intrauterine inflammation and infection.

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Dos

• To reduce the risk of endometritis caused by STIs
  • Patient should practise safe sex, such as using condoms.
  • Patient should get routine screening and early diagnosis of suspected STIs, in both herself and partner.
  • She should finish all treatment prescribed for an STI.

Don'ts

• The content in this section is in bullet points.

References

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