Obstetrics and gynecology. Endometritis (most important)

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Obstetrics and gynecology. Endometritis (most important)

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47. Endometritis

Endometritis - inflammation of the lining of the uterus (endometrium). An acute inflammatory process can be caused by a bacterial, viral, fungal, parasitic, mycoplasmal, protozoal and spirochetal infection. It is most often caused by a mixed aerobic-anaerobic association of several microorganisms. Most often, the muscular membrane of the uterus is also involved in the inflammatory process with the development of myoendometritis.

Endometritis Clinic. Signs of the disease usually appear on the 3-4th day after infection. General symptoms of infection are observed: increased body temperature to 38-39 °C, malaise, weakness, headache, neutrophilic leukocytosis with a shift to the left, increased ESR. Local symptoms appear: pain in the lower abdomen, profuse liquid serous-purulent or bloody-purulent discharge. On vaginal examination, a painful enlarged uterus of dense consistency is revealed. The acute stage of endometritis lasts 8-10 days, and with timely and adequate treatment, recovery is complete. If therapy was prescribed untimely and inadequately, then a transition to a chronic form is possible. Chronic endometritis is characterized by focal inflammatory infiltrates in the uterine mucosa, located around the glands and blood vessels, leading to structural changes in the endometrium - its atrophy, hypertrophy or the formation of small cysts. The ability of the endometrium to perceive hormonal stimulation is impaired, which leads to disruption of cyclic processes and menstrual function. The most pronounced clinical symptom is menstrual irregularity with the development of menorrhagia (hypermenorrhea, polymenorrhea) or metrorrhagia. Premenstrual and intermenstrual bleeding is less common. With chronic endometritis, infertility or recurrent miscarriage often develops, since implantation of the fertilized egg into the altered endometrium is extremely difficult. Clinical symptoms of chronic endometritis are mild. The temperature is usually normal, the patient notes scant mucopurulent discharge, aching pain in the lower abdomen and lower back. On vaginal examination, slight thickening and an increase in the size of the uterus are observed. Diagnosis of chronic endometritis is based on data from the anamnesis, clinic and histological examination of endometrial scraping. Diagnostic curettage is performed on the 8-10th day of the menstrual cycle.

Treatment of endometritis. In the acute stage of endometritis, etiotropic therapy is carried out. Antibacterial drugs are prescribed taking into account the sensitivity of the pathogen to them; broad-spectrum antibiotics are most often prescribed. The dosage and duration of antibacterial therapy are determined individually, taking into account the severity of the patient’s condition. In order to suppress anaerobic flora, Trichopolum (Flagyl, Klion) is included in the treatment complex. Depending on the severity of the condition, infusion, desensitizing and restorative therapy is prescribed. Treatment of chronic endometritis is complex, including medications, physiotherapeutic methods of treatment and sanatorium-resort treatment.

Author: Ivanov A.I.

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