metroendometritis - is combined infectious inflammation of the internal mucous (endometrium) and muscle (myometrium) of the layers of the uterus.It develops metroendometritis penetration into the uterine cavity downstream of infection of the vagina and cervix (upward path) or the fallopian tubes (the downward path).Among the perpetrators of acute infectious inflammation in the womb are more common representatives of conditionally pathogenic.Metroendometrity specific origin detected less frequently.
Once the infection gets into the uterus, develops an acute inflammation of the outer mucus layer - endometritis.Mucosal injury can not long retain pathogenic flora on the surface and it penetrates deeper, reaching the muscular layer, which also develops an infectious inflammation - myometrium.When inflammation is involved in muscular layer (metroendometritis), the disease is more pronounced.
uterus is protected from unwanted infections physiological barriers, which together wi
- inner mucosal layer of the uterus (the endometrium).It consists of two layers: the outer functional and to be, deep, basal.The functional layer occur recurring monthly Expansion Processes and rejection, he is the source of menstrual bleeding.In contrast to the functional, the basal layer is not a hormone-dependent cell has a constant composition and serves as a source of new cells for restoring mucosal integrity after partial rejection.
Due to the cyclical rejection of the functional layer is a constant renewal of the mucous lining of the uterus.In the case of penetration into the uterus of undesirable microorganisms, they are eliminated along with the functional layer, without having to penetrate the uterine wall and cause inflammation.
- glandular structures of the uterus.The endometrium is a lot of iron.In response to the presence of foreign microflora, they point out the secret that "washes out" an infection of the uterus.
- Cervical canal.It is lined with epithelium produces a lot of mucus secretion, and it accumulates like a cork in a bottle does not allow content to penetrate the vagina above.
A healthy woman's risk of infection in the uterus through the physiological barriers minimal.The undesirable scenario is possible only if two conditions - a mechanical violation of the integrity of the endometrium and reduced immune defense mechanism.Therefore metroedometrit mainly develops after birth, abortion, and other traumatic situations endometrium in women with reduced immunity.In the structure of infectious and inflammatory diseases of internal genital organs it is uncommon (0.9%), giving way to the inflammation of the fallopian tubes and ovaries.
Acute metroendometritis always starts with an infection in the functional layer of the endometrium.If the process is diagnosed and treated at the beginning of this stage, the patient can avoid negative scenario and get rid of infection by a brief and simple treatment.Unfortunately, uterine layers are closely related to each other and are well supplied with blood, so that the infection rapidly penetrates deeper.
also attempts to aggravate the situation of patients get rid of the beginning of the disease on their own.Self facilitates the well-being, but does not eliminate the infection, allowing it to penetrate deep into the muscle layer.
Inflammation in metroendometritis can not only be sharp.Subacute metroendometritis different erased clinic diagnosed and often hard evidence of exacerbation of a chronic process.
Chronic metroendometritis usually is a consequence of not cured of acute inflammation in the uterus and out of periods of exacerbation of clinically manifests itself almost.
metroendometritis pregnancy occurs infrequently in very debilitated patients.The presence in the uterus of acute infectious-inflammatory process leading to its inability to keep the developing fetus.Metroendometritis during pregnancy leads to its premature termination.
If any clinical form metroendometrity in varying degrees of severity present pain, menstrual dysfunction and abnormal discharge (leucorrhoea).Chronic sluggish metroendometritis often leads to infertility.
metroendometrity Diagnosis begins with a pelvic exam and ends with instrumental methods of examination.Diagnosis requires metroendometritis bacteriological tests to identify infectious agent.
Subacute metroendometritis patient does not always lead to the doctor's office.Coping with the symptoms of inflammation unexpressed self, it allows you to form in the womb of chronic inflammation, and ask for help when its consequences.
metroendometrity Treatment depends on the form and nature of the pathogen.Treatment begins to eliminate the infection.Antibiotic therapy is chosen according to the recommendations of bacteriological findings, which identifies the pathogen and determine the desired antibiotic to eliminate it.
only reason metroendometrity development is an infection that has penetrated into the uterus, and the only condition for its development is damaging the surface of the endometrium in women with weakened immune systems.
most common infection in the uterine cavity from the vagina rises.In 80-90% of cases, it is not introduced from the outside, and is formed of opportunistic microbes belonging to the normal vaginal microflora.In the presence of precipitating conditions microbes form unions, raised to the uterus, are a vulnerable section of the damaged mucosa and begin to multiply, penetrating into the underlying layers.When nonspecific inflammation metroendometritis provoke streptococci, viruses, staphylococci, E. coli and other microorganisms.
specific purulent metroendometritis called gonococcus and trichomonas.
To develop an infectious inflammation of the endometrium predispose:
- Complete mechanical removal (scraping) mucosa with medical diagnostic purposes or for the termination of pregnancy.Complete removal of the mucous layer leads to the formation of a large wound exposed surface containing the damaged blood vessels through which the infection is easily penetrates the uterine wall to the myometrium.The presence of blood in the uterine cavity after total removal of the mucosa also contributes to the development of infection, since blood is the ideal medium for its propagation.
- Injury uterine cavity during diagnostic procedures: aspiration biopsy, hysteroscopy, and similar sounding.Even a small wound in the uterus serves as a gateway for infection.
- Improper conduct intrauterine manipulations, when the infection gets into the womb due to non-compliance with the rules of asepsis.
- IUD.She threads pathogens are able to penetrate into the uterine cavity.
- disrupt the normal vaginal biocenosis.Excessive development of opportunistic pathogens in the vagina, not only provokes local inflammation, but also reduces the protective properties of the cervical mucus, it becomes unable to contain the infection, passing it to the uterus.Metroendometritis often develops in the presence of bacterial vaginosis.
- Genital infections.The specific microflora has the ability to spread rapidly from the vagina to the surrounding tissues, causing acute purulent inflammation.
acute infectious inflammation of the uterus sometimes (2-5%) develops in the first three or four days post-partum period.Postpartum metroendometritis due to natural causes:
- puerperal depletion of immune protection, especially after complicated deliveries;
- presence in the uterus at the site of the wound surface breakaway placenta;
- congestion in the uterine cavity of the blood;
- violation of the contractile ability of the uterus, resulting in the uterus can not be in time to restore its original structure and size, longer stays soft, "loose" and vulnerable to infection.
Postpartum metroendometritis provoke labor, complicated trauma of the birth canal, the delay parts of the placenta in the uterus, heavy bleeding.
physiological causes of metroendometrity is normal menstruation, when the uterus "opens" to evacuate rejected by the mucous layer.
Symptoms and signs metroendometrity
Getting downstream of the external genitalia in the endometrium, the infection causes a series of inflammatory changes in the form of swelling and thickening of the mucus layer, expanding blood vessels.On the surface of the inflamed mucosa appear foci of purulent fusion, and then they are subjected to necrosis and rejected.Edematous mucosa becomes loose, razvoloknyaetsya and seamlessly transmits pathogens into the deeper layers.In response to the inflammation of the prostate begin to work, as a result, the patient appears abnormal discharge.
After penetration into the uterus infection disease can develop in different ways.If the uterus has a delimited portion of the damaged mucosa, infection occurs locally, and its clinical manifestations consistent subacute inflammation.When the infection manages to capture the entire uterine cavity, the disease begins acutely.Sluggish metroendometritis can not disturb the patient for years, reminding me of themselves small symptoms only during periods of exacerbation.
Joining always means inflammation of the myometrium worsening clinical situation.
Usually, the acute phase of inflammation lasts no more than ten days.With early diagnosis and proper treatment of inflammation of the wound.If the treatment was ineffective, sluggish metroendometritis develop chronic symptoms with dim.
metroendometritis not all patients equally occurs and depends on the type of infection and disease state forms of immunity.However, there is an unambiguous list of symptoms that indicate the presence of an infectious inflammation of the uterus.Regardless of the reasons metroendometrity patients are always present:
- Pain in the pelvic area.When the infection is localized only in the endometrium, the pain can be moderate and not to affect the well-being of the patient, so often in the initial stages of inflammation patients rarely seek help coping with the symptoms of his own.Meanwhile, the pathogens continue to multiply, gradually penetrating into the deeper layers of the uterine wall.When the infection reaches the myometrium, it provokes strong, sometimes unbearable abdominal pain, radiating to the back, groin, or rectum.
- seropurulent or pus, which are well visualized during the inspection.Their amount depends on the cause of the inflammation.Gonococcal infection provokes copious purulent discharge, irritating the tissue of the vulva and urethra.When the infection destroyed the mucous begins to be torn away in an admixture of blood secretions.Odors cables appear in the presence of E. coli in them, or trichomonas.
- Characteristic signs metroendometrity palpation.Gynecological examination, palpation (palpation) of the uterus is always accompanied by severe pain.
It should be noted that the diagnosis metroendometritis considered valid only if there is a history of provoking the moment, that is, damage to the endometrium.Usually, the symptoms of acute inflammation occur 3-4 days after infection of the uterus after abortion or childbirth instrumental manipulation.
metroendometritis diagnosis requires laboratory and instrumental confirmation.It shall be required:
- A study of the results of a blood test.Increasing the number of leukocytes and ESR indicates inflammation.
- smears of vaginal and cervical secretions to determine the microbial composition and evaluate the severity of the inflammatory process.Smear microscopy "flora" in metroendometritis reveals a large number of white blood cells and the presence of pathogenic microorganisms.
- Bacteriological examination (bakposev) cables is of paramount importance, since in addition to the identification of the pathogen indicates the desired antibiotic to eliminate it.
- Transvaginal ultrasound scan.To evaluate the state of the uterus and pelvic in particular.Identify typical inflammatory signs in the womb: the unevenness of mucous and its thickening, changes in the density of the myometrium.It can also detect blood clots or pieces of placenta in the uterine cavity.
When the inflammatory process involves the fallopian tubes and ovaries, ultrasound determines them well.
Additional tests are carried out to clarify the nature of the inflammation or the presence of comorbidities.
When metroendometrity difficulties in diagnosis, especially chronic, resorting to laparoscopy.
Island metroendometrity precede childbirth, abortion or medical diagnostic manipulations in the uterus.Once infection has penetrated into the endometrium, three or four days of the first symptoms of the disease.The disease always begins with acute deterioration of health, fever, purulent or seropurulent cables and severe pain.
When the uterine cavity is part of the ovum after an abortion or a fragment of the placenta after childbirth, acute metroendometritis accompanied by bleeding.
Gonococcal infection can mimic the menstrual function and exhibit prolonged menstruation or intermenstrual bleeding.
During the inspection visualized copious purulent discharge from the opening of the cervical canal.Uterine palpation and painful displacement may be slightly enlarged and softened.
occupies a special place metroendometritis postpartum because it is a serious obstetric complications, and threatens the health of the patient.After delivery, the uterus is extensive damage to the inner layer at the site of the placenta tearing away.To mucous layer recovered, it takes a few days, but until then the uterus is very vulnerable to infection.
Postpartum metroendometritis often formed when:
- cesarean delivery;
- pronounced changes in the immune system;
- prolonged labor and prolonged (over 12 hours), dry period;
- there is an infection of the vagina or cervix.
Postpartum metroendometritis clinically later, three days after the birth and has all the signs of acute inflammation in the uterus.There are severe pain, fever and malaise.Allocation instead of physiological sukrovichnyh turn brown and become unpleasant putrid odor, a week later they become purulent.
inflammation in metroendometritis peculiarity is the frequent spread of infection in the fallopian tubes.If the infection is not only in the uterus, but also in its appendages, clinical signs of illness complemented salpingitis (inflammation of the fallopian tubes) and oophoritis (inflammation of the ovaries).
Early acute complications are also metroendometrity:
- penetration of infection into the bloodstream and the development of septic complications ("blood poisoning");
- pyometra formation - accumulation of pus in the uterine cavity because of the blockage of the cervical canal;
- pelvioperitonit - accumulation of pus in the pelvic cavity;
- the transition of acute inflammation in chronic.
metroendometrity By late complications include infertility, menstrual dysfunction and chronic pelvic pain.
Chronic metroendometritis has no distinct features.Sometimes he is asymptomatic, making it difficult to diagnose.Aggravation metrooendometrita, usually accompanied by a slight fever, mild aching pelvic pain and constant serous-purulent discharge.