Endometritis - this inflammatory changes in the mucous layer of the uterus after exposure to a septic infection or other pathogenic microorganisms.The inflammatory process in the endometritis is sharp, bright accompanied by symptoms or able to flow in chronic malosimptomno form. of chronic endometritis is due to late or incorrect treatment of acute inflammation.Chronic inflammation is clinically manifested only in periods of exacerbation.
pathogenic microorganisms penetrate into the uterine cavity downstream of the cervical canal and vagina.It is also a source of inflammation in the uterus can become a downward infection penetrating into the cavity of her fallopian tubes.
only cause of endometritis is the infiltration into the uterus of pathogens.Endometritis developed with a weak immune system and a healthy woman of endometrial infection is eliminated by internal defense mechanisms, and inflammation occurs.
In healthy women, the uterus is protected from adverse impacts.Cervi
clinical picture of inflammation of the endometrium depends on several factors:
- The character of the pathogen.Acute suppurative endometritis with bright specific symptoms provoke infection (gonorrhea).Non-specific inflammation can occur with significantly symptomatic.
- The extent of inflammation.Uterine wall is formed by several layers, they are closely related and have no protective barriers separating, so infection is relatively easy to penetrate deep into the uterine wall.If the pathological process involved not only mucosal and muscular layer, symptoms of severe acute infections.A feature of the long-existing infectious inflammation in the uterus is that it can go to the fallopian tubes upward path.In this situation, the clinical picture is supplemented endometritis signs of infertility.
- forms of the disease.Acute process has always manifested clinically, and the symptoms are mild chronic endometritis.
- the presence of associated gynecological pathology.Sometimes endometriosis develops in the inflammatory changes of the vagina and cervix, or combined with the inflammatory process in appendages.
Among the signs of endometritis are always a pain, menstrual irregularities and abnormal discharge, and the nature of their severity depend on the form of the disease.
Diagnosis and therapy of acute endometritis, usually does not cause difficulties.However, sometimes the symptoms of endometriosis are not expressed clearly, and women do not pay them enough attention.The inflammatory process is long and eventually becomes chronic.
endometritis therapy is conducted according to the form of the disease.Of great importance is the time factor.Unfortunately, the majority of inflammatory processes in the endometrium untimely diagnosed as women try to cope with the disease and seek help too late.Chronic inflammation of the endometrium is more difficult to diagnose and treat.
Any scheme of endometritis treatment involves antibiotics.Required antibiotic is chosen based on bacteriological conclusion.
Chronic endometritis is often accompanied by menstrual dysfunction, and infertility.Therefore, after the step of antibiotic therapy treatment is aimed at eliminating the hormonal dysfunction and restore the ability of fertility in young women.
immediate cause of endometritis is infection, penetrated into the uterine cavity.The ascending route of infection (from the vagina into the uterus) is the most common.In 80-90% of cases the source of the inflammation of the endometrium are aerobic and anaerobic opportunistic microorganisms that are part of the normal flora of the genital tract.Less common cause of acute suppurative endometritis are the causative agents of genital infections.Specific suppurative endometritis can cause gonorrhea and trichomonas.
Usually, inflammation is not caused by a single microorganism and microbial association in which may include streptococci, staphylococci, E. coli, viruses, fungi and other microorganisms.
However, once on the endometrium, the infection does not always provoke endometritis.Such a scenario is possible only under the condition of reduced immunity and the presence of possessing factors.These are:
- destroying the integrity of the mucous layer of the uterus.After the diagnostic or therapeutic tool in the manipulation of the uterine cavity on the inner surface are damaged.If at this point the uterus becomes infected, it can easily penetrate the mucous layer defenseless through the damaged areas and provokes the development of endometriosis.The inflammation in the uterus may begin after hysteroscopy, aspiration biopsy, these sensing and manipulation.
- Complete removal of the inner mucus layer during an abortion, as well as dilatation and curettage.The inner surface of the uterus after these manipulations is a huge wound surface with exposed blood vessels.Caught her pathogens rapidly provoke an acute inflammatory process.
- Introduction of an intrauterine device.Sources of infection can ascend into the uterine cavity of the spiral filaments, or their ability to bring health workers with poorly treated tools.
- Incorrect observance of sanitary norms during manipulation in the uterine cavity in patients with poor immune systems.
At the heart of the development of endometriosis sometimes may be physiological reasons.Acute endometritis often diagnosed after physiological birth and leads all septic obstetric complications.Also, the favorable situation for the development of inflammation in the uterus is menstruating.After the rejection of endometrial uterine lining is similar to that after the abortion.
Endometritis can develop the type of focal inflammation, when the infection is within the damaged tissue.With the spread of pathological changes cover the entire endometrium.
Isolated inflammation of the surface layer of the uterus there long.The close connection of all segments of the uterine wall and good vascularization favor the penetration of infection deeper into the muscle layer.
infrequent cause of endometritis is a descending infection, penetrating into the uterus of the upstream of the fallopian tubes, intestines or appendix.
Symptoms and signs of endometritis
originally penetrated the uterus infection always provokes acute inflammation of the mucous layer of the surface.If the inflammatory reaction develops in the delineated area of the endometrium, the clinical signs of the disease will be expressed slightly.Patients in these situations have resorted to self-medication, but their efforts did not help get rid of the disease, but only on its symptoms.Meanwhile, the long flowing subacute inflammatory process in the uterus without proper treatment in time transformed into a chronic endometritis.
Otherwise, the situation is developing with extensive infectious-inflammatory process in the endometrium.Disease begins acutely, after three or four days after infection.Acute postpartum endometritis also apparent within the fourth day.
infection in violation of protection mechanisms along the cervical mucus of the cervical canal into the uterus rises, provoking a series of pathological changes: dilation of blood vessels, swelling of the mucous layer and thickening (hyperplasia), the formation on the surface of the mucous layer of purulent plaque with subsequent necrosis and rejection.Glands located in the mucous layer, squeezed by growing swelling and begin to vigorously develop the inflammatory secret and patient appear abundant vaginal discharge.
If endometriosis is based on a specific infection, discharge from the uterus becomes purulent.Due to the inflammatory swelling of the mucous layer becomes loose and razvoloknyaetsya to be layers of the uterine wall are vulnerable to developing infections, it easily penetrates deeply into the muscle layer, the patient's condition becomes severe.
the presence of chronic inflammation in the endometrium are constant processes of injury (acute period) and healing (remission) of the mucous layer.This produces portions proliferation of connective tissue, which interfere with the normal cyclic operation of the endometrium.The mechanisms of normal proliferation and exclusion violated the inner mucus layer, so patients with chronic endometritis there menstrual dysfunction with proper operation of ovarian hormone.
infections in developing endometritis not all patients equally, so the symptoms can also vary from a small number of clinical signs until pronounced symptoms of acute inflammation.However, there are a number of clinical signs of endometriosis, which indicate the presence of inflammation indisputable in the uterus, and characterizes the degree of severity of disease severity.
When endometritis of any origin, the patient present:
- purulent or mucopurulent vaginal discharge.On examination, you can see that they are derived from the external opening of the cervical canal.If the composition of microbial associations caused by inflammation, there is E. coli, isolation are bad, putrid smell.Blood in the secretions indicates the processes of destruction of mucous membranes and rejection.
Chronic catarrhal endometritis is characterized by a constant turbid watery discharge.However, the development of chronic catarrh of the uterus occurs infrequently, and allocate catarrhal endometritis in the classification of forms of the disease impractical.
- Pain in the pelvic area.Their expressions ranging from minor pulling or aching to acute and unbearable.Sometimes the pain radiating to the lower back, pelvis, groin, rectum.
- gynecological examination, palpation of uterine endometritis is always painful, but the severity of the pain depends on the nature and degree of inflammation its spread.When the inflammatory process proceeds to the muscle layer, palpation of the uterus and parametrium area becomes sharply painful.
often at the doctor's question sounds as frequent endometriosis and pregnancy with a good outcome.In 10% of patients with chronic endometritis formed persistent infertility, and every second endometriosis and pregnancy ends its premature termination.
endometritis Complications associated with the spread of the infection outside the uterus.In acute endometritis in patients with reduced immune defense mechanisms of the infection gets into the fallopian tubes and ovaries.Sometimes, due to the pronounced inflammation develops occlusion (blockage) of the cervical canal, and purulent discharge can not be evacuated from the uterine cavity is formed pyometra - a uterus filled with pus.
Patients with chronic inflammation in the uterus often present constant pelvic pain, menstrual dysfunction.Structural changes of the inner layer in chronic inflammation can lead to incorrect "healing" mucosa when endometrium penetrates into the underlying layers and there begins to operate cyclically, i.e. there is a formation of endometriosis.
Acute endometritis is diagnosed in 9.7% of cases of acute pelvic inflammatory processes.
Acute endometritis is formed after the abortion, curettage uterine cavity for therapeutic or diagnostic purposes, as well as after birth.If clinical disease is present one of these provoking moments to talk about endometritis inappropriate, since the uterine cavity infection is possible only in the case of traumatic injury of the endometrium.
After three or four days after the infection begins to increase the temperature to subfebrile or very high (up to 40 ° C) figures, sharply deteriorating health, there are severe pain in the lower third of the abdomen radiating to the rectum, pelvis or groin area.If the inflammatory process involved the myometrium, the patient describes the pain as diffuse, without precise localization.
Severe fever may be accompanied by nausea, vomiting, headaches, weakness, tachycardia.
Secretions are abundant acquire seropurulent character.Damaged mucosa infection of the uterus does not have time to regenerate (to recover), so the discharge from the uterus for a long time can be sukrovichnym.
Inflammatory changes in the uterus leads to wrong rejection pathologically altered endometrium during menstruation, resulting in giperpolimenoree - prolonged and heavy bleeding instead of a normal menstrual period.
Acute specific inflammation in the uterus provoked gonococci, often manifests itself only in the form of bleeding, prolonged menstruation masquerading or intermenstrual bleeding.
Abnormal vaginal discharge accompanied by a large number of gynecological diseases, so this feature may not indicate the presence of endometriosis without accompanying inflammation-specific symptoms - fever, pain, feeling unwell.
Sometimes acute endometritis after abortion is associated with incomplete evacuation of the uterus.The uterus is the presence in it remnants of the ovum, its membranes or blood clots can not properly cut, so the patient begins profuse bleeding dark clots.
acute stage of inflammation in the uterus lasts no more than ten days, with adequate treatment process is terminated, rarely can be transformed into a subacute or chronic inflammation.
At the first warning signs of trouble in the pelvic region the need for timely diagnosis and adequate therapy.Unfortunately, patients are often correlated with the state of his weathered gynecological procedures or childbirth, and mistakenly believe that it is temporary and can go after simple self-treatment measures.
longer an acute infectious inflammation of the uterus is left without proper attention, the higher the risk of complications.The inflammatory process may spread to surrounding structures - of the uterus (developing salpingo), pelvic peritoneum (pelvioperitonit) or tissue surrounding the uterus (parameter).
have chronic endometritis there are no distinctive clinical features.Typically, the disease has symptoms similar to acute inflammation, but expressed much weaker.
When properly collected history can always find the previous episodes of acute inflammation of the uterus, which took place without adequate treatment or has not been treated properly.
Typically, patients with chronic endometritis pay attention to frequent unmotivated rise in temperature that does not exceed subfebrile values intermenstrual uterine bleeding.Menstruation due to the decrease uterine contractility, and increased permeability of the uterine blood vessels may become longer, and be accompanied by a large loss of blood and pain.
Change secretory function is expressed in increasing the amount of vaginal discharge, often they acquire seropurulent character.
persistent symptoms of chronic endometritis are aching pain in the lower abdomen.