endometritis
Introduction
Introduction to endometritis Endometritis is an inflammation of the endometrium that is common in women. According to the length of the disease, it can be divided into acute endometritis and chronic endometritis. Acute inflammation may cause serious consequences such as diffuse peritonitis and sepsis leading to septic shock. basic knowledge The proportion of illness: 0.02% Susceptible people: women Mode of infection: non-infectious Complications: uterine empyema, acute diffuse peritonitis, sepsis, septic shock
Cause
Causes of endometritis
Causes of chronic endometritis:
(1) Although the endometrium is periodically exfoliated, its basal layer is not exfoliated. Once the basal layer has chronic inflammation, it can infect the functional layer of the intima for a long time, leading to chronic endometritis. The presence of tuberculous endometritis is the same as this mechanism.
(2) Long-standing tubal oophoritis or severe cervicitis can lead to chronic endometritis.
(3) The contraceptive can cause chronic endometritis.
(4) A small amount of placenta remains during childbirth or postpartum, or the recanalization of the placenta attachment is often the cause of chronic endometritis.
(5) Postmenopausal women, due to the significant decline in estrogen levels in the body, the endometrium and vaginal mucosa become thin, vulnerable to pathogens, leading to inflammation. Clinically, endometritis and vaginitis often coexist.
(6) uterine submucosal fibroids, mucosal polyps may also lead to chronic endometritis.
(7) Chronic endometritis with no obvious cause may also be present. Most of the pathogens come from the flora in the vagina.
The cause of acute endometritis:
(1) Unsanitary, menstrual sexual intercourse or sexual life disorder brings pathogens in vitro or in the vagina and cervix into the uterine cavity.
(2) The intima of mild infection is only hyperemia, edema, polymorphonuclear leukocytes and round cell infiltration. Severe infection can cause suppuration, extensive necrosis, and can accumulate the muscle layer underneath to form acute uterine myositis.
Prevention
Endometritis prevention
Prevention plan
(1) Comprehensive gynaecological examination before and during abortion, timely detection of acute and chronic inflammation of the genital tract and treatment to prevent bacterial infection after abortion or postpartum.
(2) Choose a regular hospital for abortion surgery or childbirth. Insufficient disinfection during surgery or delivery is an important cause of acute endometritis and should be taken seriously.
(3) Pay attention to personal hygiene after postpartum or abortion surgery, do not use unclean sanitary napkins, sanitary napkins are replaced in time, and sexual intercourse is prohibited.
(4) As a pregnant woman, prenatal care should be carried out regularly at a designated hospital for prenatal examination, receiving health guidance during pregnancy, and actively treating chronic diseases such as malnutrition and anemia to enhance physical fitness.
(5) Prohibition of sexual life in late pregnancy. Pay attention to diet after childbirth, eat nutritious foods that are easy to digest, rich in protein and vitamins, and maintain good physical condition. When the lochia is not discharged, take a semi-recumbent position to facilitate the discharge of lochia.
(6) In general, women should also pay attention to personal hygiene. When there is bleeding in the vagina, sexual intercourse is absolutely forbidden.
Complication
Endometritis complications Complications uterine empyema acute diffuse peritonitis sepsis septic shock
Common complications
1. Chronic endometritis may be complicated by uterine empyema or uterine perforation.
2. Acute endometritis may cause serious consequences such as diffuse peritonitis, sepsis and septic shock.
Symptom
Endometrial inflammation symptoms Common symptoms of leucorrhea increased purulent leucorrhea leukocytosis lumbosacral sore pelvic pain dysmenorrhea cold warfare lower abdominal pain menstrual volume decidual reaction
Chronic endometritis
symptom:
(1) Pain in the pelvic area: About 40% of patients complained of pain in the lower abdomen and pain in the lumbosacral region during the menstrual interval.
(2) increased vaginal discharge: due to increased secretion of endometrial glands. Generally it is a thin watery sample, light yellow, sometimes bloody leucorrhea.
(3) Menorrhagia: The menstrual period is still regular, but the amount of menstruation is doubled, and the bleeding period is also significantly prolonged. Only a very small number of patients cause anemia due to massive bleeding, which may be due to thickening of the intima and inflammation. Irregular bleeding is rare, sometimes it can be bleeding for a few hours or for 1 to 2 days to stop.
(4) dysmenorrhea: more occurs in unmarried women, but severe dysmenorrhea is rare, may be due to excessive thickening of the intima, hinder the normal degeneration and necrosis of the tissue, stimulate the excessive contraction of the uterus.
Signs:
(1) Patients with mild inflammation, double diagnosis can be found without abnormal conditions, so the clinical diagnosis is dysfunctional uterine bleeding. Some people in 1000 patients with dysfunctional uterine bleeding for pathological examination, found that 11% are endometritis.
(2) If there is uterine empyema, the uterus is spherically enlarged, soft, and even a mass can be found in the upper midline of the pubic symphysis, tenderness. If the secretion can be intermittently discharged through the neck tube, bloody pus can be seen when the speculum is examined, which is strangely odorous. Often there is acute vaginitis.
2. Acute endometritis
(1) Symptoms:
The onset is more urgent, there is chills and even chills, fever (38 ~ 40 ° C), pulse speed, general weakness, sweating, lower abdominal pain, drama, falling, backache. A large number of bloody, purulent or watery leucorrhea, and smelly. Postpartum infections are muddy.
(2) Signs:
The patient has tenderness in the lower abdomen. Speculum examination revealed a large amount of purulent or fouling bloody odor secretions in the uterus. Cervical pain during double consultation. The palace body is swollen due to congestion and edema, soft and tender. The test showed the total number of white blood cells and neutrophils.
Examine
Endometritis examination
1. Gynecological routine examination
Gynecological routine examination is a routine gynaecological examination of women, divided into gynecological specialist physical examination and related auxiliary examination.
2. Diagnostic curettage
Curettage is to open the cervix with a metal dilator so that the curette can enter the uterus to scrape the endometrium. This type of curettage is used for biopsy to diagnose endometrial abnormalities.
3. Vaginal secretion examination
The normal leucorrhea is white, mushy, and has no odor. If the ovulation period is near, the leucorrhea is more clear and transparent, and the egg is clear, the amount is more. After the ovulation period, the leucorrhea is white, turbid, and more viscous, with less amount.
Diagnosis
Diagnosis and diagnosis of endometritis
diagnosis
According to medical history, clinical manifestations and signs are easy to diagnose. When vaginal examination, the uterine cavity drainage should be taken as far as possible to send bacterial culture and drug susceptibility test, and smear test bacteria for reference. Repeated vaginal examinations should be avoided to prevent the spread of infection.
Differential diagnosis
Combined with the history of infection, vaginal discharge and increased menstrual flow, pelvic area pain and dysmenorrhea, these four symptoms are of great value to the diagnosis. Diagnosis can determine the cause of the disease and exclude malignant lesions.
1. Endometrial cancer.
2. Cervical cancer.
