What is purulent endometritis? Endometritis (inflammation of the uterus), symptoms, treatment, folk remedies Purulent endometritis in women treatment

Endometritis in the general sense of the word is an inflammation of the inner lining of the uterine cavity, that is, the functional layer of the endometrium. The deep-lying basal layer suffers much less often, which is due to the peculiarities of the anatomy of the fairer sex. Nevertheless, this is also possible.

Much more dangerous is the advanced phase of the pathological process, purulent endometritis in women. This is a potentially fatal lesion of the pelvic organs with expansive spread. It is possible that the process may develop and spread to the ovaries and myometrium. Ultimately, purulent tissue melt, sepsis and death are possible. That is why it is so important to identify purulent endometritis in a timely manner.

Why does purulent endometritis occur? There are 3 groups of causes for the development of pathology. The first concerns the penetration of pathogenic microorganisms. The second category is a decrease in general and local immunity. It cannot be done without trigger factors that determine the onset of the pathological process. We should consider them in more detail.

Infection

Which pathological microorganisms can provoke the development of a pathogenic process:

• Pyogenic flora.

Primarily Staphylococcus aureus. This microorganism is a real scourge of modern man, since it is characterized by significant contagiousness and significant resistance to any therapy. Hence the probability of defeat. In addition, Staphylococcus aureus has a significant ability to dissolve tissue, causing a purulent melt. This makes him extremely dangerous and aggressive.

Another “brother” of staphylococcus is streptococcus. It is less dangerous, but can also provoke the development of purulent endometritis in the fairer sex. In addition, this bacterium is distinguished by its ability to decompose blood cells, causing secondary anemia.

• Various types of sexually transmitted infections.

There can be a lot of options here. From syphilitic spirochetes, to Trichomonas, gonococci and many other representatives of this type of flora. As practice shows, they are the ones who in most cases make up the purulent flora of endometrial inflammation. Also, all specified and designated microorganisms are extremely aggressive.

• Herpes viruses.

From the first to the fifth types. They can provoke a purulent inflammatory process, but this is relatively rare.

Routes of infection:

Sexual path. Both classical and oral-genital sexual contacts are dangerous. It is necessary to observe adequate contraception and protect yourself, although this does not guarantee the absence of the likelihood of one or another agent entering the body.

Contact path. It involves the penetration of infection into the body without sexual contact. During the interaction of the physical plane, however.
The hygienic way. It involves using non-sterile hygiene items, such as tampons. This is a direct way to become a carrier of bacteria, viruses and other structures.

Mechanical way. With dirty hands.
The placement of the so-called intrauterine contraceptive also has an effect. This is a vicious practice that leads to septic inflammation in the uterus at different levels of this organ.

Immunity

The immune system keeps bacteria, viruses and fungi at bay. But as soon as the defense misfires, the flora begins to develop. Hence the likelihood of developing diseases. Including purulent endometritis. Why does immunity decrease?

Smoking tobacco for a long period of time. It is especially dangerous for the fairer sex due to the peculiarities of its anatomy. Causes a generalized decrease in the intensity of the immune system.

Alcohol abuse. Causes exactly the same effect as smoking. The maximum permissible amount of alcohol per day is no more than 30-50 ml of dry red wine. No more. Vodka, beer and other drinks are not recommended.

Too much antibiotics. Antibacterial agents are drugs that have a clear purpose and are used in specific cases. You cannot drink them on your own. Is it dangerous. Namely, immunity decreases and the resistance of microorganisms increases.

Excessive consumption of oral contraceptives. Another factor that artificially changes hormonal levels and provokes the development of severe disorders of the immune system.

Other factors are not so significant. Among them, for example, the use of cytostatics as part of chemotherapy. It is required to carefully approach the issue of diagnosis and restoration of protective forces.

Triggers

In what cases does endometritis occur and how does it transform into a purulent form? There are several answers. All of them are hidden within the trigger factors:

• Operations on the uterus of any nature. Including diagnostic and therapeutic curettage, therapeutic measures as part of abdominal operations, abortions, etc.
• Traumatic lesions of the uterus of a different kind. For example, during excessively intense sexual intercourse with deep penetration. Is it dangerous.

All three groups of reasons need to be considered together. This is the key to determining the source of the disease.

Symptoms

The symptoms of purulent endometritis, even in mild cases, are obvious. They are hard to miss and even harder to ignore. Among the characteristic manifestations are:

• Intense pain in the lower abdomen. Accompanies the patient constantly. Characterized by severe pain, burning, and a feeling of pressure. The feeling can also be pulling, depending on the individual characteristics of the body. The pain radiates (gives) to the legs, lower back, external genitalia, and back.

• Menstrual irregularities. Typically a type of menorrhagia, where too much menstrual blood is released. This is fraught with anemia, the development of sideropenic and anemic syndromes (typical).
• Bleeding between cycles. They always develop and have varying degrees of intensity.
• Increased duration of the menstrual cycle (so-called opsomenorea).
• Painful periods (dysmenorrhea).
• Vaginal discharge of a clear or purulent nature. Also always occurs. Develops against the background of infection.
• Increase in body temperature to significant levels.
• Feeling hot, chills.
• Symptoms of general intoxication of the body, including headache, dizziness, joint pain, etc. Tachycardia is possible; this is an alarming sign indicating a significant spread of the pathological process.

It is necessary to consider all symptoms together to determine a possible disease.

Diagnostics

Diagnosis of purulent endometritis in women is the work of a gynecologist or obstetrician-gynecologist. At the initial appointment, an oral interview is conducted with the patient. A life history is collected. If the patient was admitted by ambulance (which is also often the case with a purulent form of the disease), all questions should be kept to a minimum. Objective studies are prescribed:

• General blood analysis. It gives a picture of severe inflammation with high ESR levels and leukocytosis above normal.
• Ultrasound examination of the pelvic organs (ultrasound). Allows you to determine the degree of tissue damage and the nature of the pathological process.
• A smear from the genital tract to determine the specific pathogen and its sensitivity to drugs.
• Bacteriological culture of leucorrhoea. Helps determine a specific treatment regimen.
• PCR, ELISA studies in extreme cases.

The system of these measures is quite sufficient. It is necessary to begin therapeutic intervention as quickly as possible.

Treatment

Treatment is also carried out by gynecological specialists. Therapy mostly comes down to taking medications from several pharmaceutical groups. Among them:

• Antibiotics. Usually in loading doses. Specific names are selected by the doctor based on the specific situation.
• Antiseptic solutions for local treatment.
• Anti-inflammatory non-steroidal origin. Relieves inflammation and pain.
• Analgesics for pain relief.
• Antispasmodics. For the same purposes.

If a purulent melt begins, it is necessary to sanitize the lesion using surgical methods. By resection of part of the uterus. In extreme cases, the entire uterus is excised, but this is rather an exception to the rule.

Complications

Purulent endometritis is dangerous due to its complications. Among them:

• Fertility disorders. If timely treatment is not started, numerous adhesions will develop. Hence the decrease in fertility to zero and infertility.
• Sepsis. It's blood poisoning.
• Purulent tissue melt.
• Formation of fibrin strands in the peritoneum (adhesions).
• Peritonitis. Inflammation of the peritoneal walls.
• Death.

Purulent endometritis is extremely dangerous in nature. This is a potentially fatal disease. It is required to approach the issue of treatment with full responsibility. This applies to both the patient and the doctor.

Endometritis should be understood as the development of an inflammatory process in the uterine mucosa or endometrium (hence the name). The disease is quite common and is often accompanied by inflammation of the muscular layer of the uterus (metroendometritis, endomyometritis).

The structure of the endometrium changes during the menstrual cycle, each time it grows and matures again, preparing in case of fertilization for the implantation of an egg, otherwise it is rejected. With a healthy endometrium, the uterus is protected from various infections. However, sometimes favorable conditions are formed for the penetration of infectious agents into the uterus, which results in inflammation.

The course of the disease is characterized by several forms - acute and chronic.

Symptoms and mechanisms of development of acute endometritis.
The development of acute endometritis can be provoked by various types of gynecological manipulations inside the uterus (hysteroscopy, diagnostic curettage, childbirth, mini-abortions, “poor-quality” abortions when remnants of the fertilized egg or placenta remain, etc.). All this creates favorable conditions for the development of infection and inflammation in acute form.

Postpartum endometritis is considered the most common infection that develops after childbirth (about 20% of cases after natural childbirth, 40% of cases after cesarean section). All this is due to changes in the female body, which are hormonal and immune in nature, as well as weakening of the immune system and general resistance to various infections.

Non-specific endometritis is characterized by the absence of pathogenic microflora in the uterine cavity. They can be provoked by bacterial vaginosis, HIV infection, and the use of intrauterine (IUD) and hormonal contraceptives.

As a rule, the development of an acute form of endometritis is observed after a couple of days from the moment of infection. Symptoms of the disease are increased body temperature (as a result of chills), severe pain in the lower abdomen, the appearance of unpleasant-smelling vaginal discharge, painful urination, and rapid pulse. It should be noted that if a woman has an intrauterine device, the disease develops rapidly and more severely.

When examined on a gynecological chair, a specialist, in the case of acute endometritis, notes a moderately enlarged uterus, its soreness, as well as the presence of discharge of a sanguineous or purulent nature. The acute form of the disease persists for seven to ten days; in case of timely and optimal treatment, it is completely cured, otherwise the disease becomes chronic.

Symptoms of chronic endometritis.
Chronic endometritis most often develops against the background of undertreatment of the acute form. In more than eighty percent of cases, this form of the disease occurs in patients of reproductive age, and the number of cases is steadily increasing, which is associated with an increase in demand for intrauterine contraception, an increase in the number of artificial terminations of pregnancies, diagnostic and therapeutic procedures inside the uterus. Chronic endometritis very often causes such a serious complication as infertility, provokes miscarriages and failure to carry a pregnancy to term, and also complicates the course of pregnancy, the process of childbirth and the postpartum period.

In the diagnosis of this stage of the disease, high-precision immunocytochemical diagnostics are used to identify the infectious agent. Often the chronic form occurs with no visible signs of microbial infection. The signs by which the disease is detected in a chronic form are thickening of the uterine mucosa, fibrous adhesions, serous plaque, and bleeding. The severity of chronic endometritis lies in the depth and duration of structural changes in the endometrium.

The main symptoms of this disease are menstrual irregularities, uterine bleeding, serous or purulent, pathological bleeding, pain during sexual intercourse, and constant pain in the lower abdomen. During examination on the gynecological chair, patients are diagnosed with compaction and an increase in the size of the uterus. In the case of chronic endometritis, the growth of cysts and polyps may be observed.

Causes of endometritis.
Considering the above, the main reason for the development of endometritis is damage to the uterine mucosa (mechanical, chemical, thermal), which provokes the onset of the inflammatory process. However, there may not be any serious complications in this case. In this situation, decreased immunity and failure to comply with basic hygiene rules (too frequent douching, use of spermicides) play a negative role, which leads to the development of inflammation. Damage to the uterine cavity can be observed in several cases: curettage (abortion, suspected cancer), probing, hysterosalpingography (a method for examining the uterus and fallopian tubes more often in the treatment of infertility), hysteroscopy, the introduction of intrauterine contraception, non-compliance with douching rules.

In addition, birth injuries (various ruptures), the use of tampons during menstrual bleeding (an ideal environment for the development of infection), as well as chronic stressful situations and overwork, which weaken the body's protective functions, can contribute to the development of endometritis.

Diagnosis of endometritis.
When detecting endometritis in acute form, anamnesis data, the woman’s complaints, observed symptoms and signs, examination by a gynecologist, blood test and bacterioscopic analysis are taken into account. Patients with this form of the disease are treated in a hospital setting, since there is a high probability of developing septic complications (peritonitis, pelvioperitonitis).

To accurately diagnose chronic endometritis, in addition to symptoms and medical history, diagnostic intrauterine curettage is performed. To confirm the diagnosis, the altered endometrium undergoes histological examination. In addition, ultrasound and endoscopic examinations are prescribed to identify structural changes in the endometrium.

Treatment of acute endometritis.
The acute stage of the disease is treated in an inpatient setting, with bed rest, absolute rest and a balanced diet in compliance with the drinking regime. Antibacterial treatment plays a leading role in the treatment of the disease (the sensitivity of the pathogen to certain antibiotics is first determined). The most commonly prescribed drugs are Amoxicillin, Kanamycin, Clindamycin, Gentamicin, Ampicillin, Lincomycin, etc. Combination treatment with several antibiotics may be observed in cases of mixed microbial infection. Often, against the background of anaerobic infections, metronidazole is included in therapy.

To eliminate severe intoxication, intravenous administration of solutions of salts and proteins up to 2.5 liters per day is recommended. Treatment also includes antihistamines, antifungals, multivitamin complexes, immunomodulators, and probiotics.

To relieve pain and inflammation, as well as to stop bleeding, apply cold to the stomach (two hours, half an hour break).

After the acute manifestations of the disease have weakened and been relieved, therapy includes physiotherapy and hirudotherapy (leeches).

Treatment of endometritis in chronic form.
To treat the chronic form of the disease, step-by-step antimicrobial, immunomodulatory, restorative, and physiotherapeutic therapy is used. Initially, treatment is aimed at eliminating the pathogens, and then at restoring the endometrium. Most often, broad-spectrum antibiotics are prescribed (for example, Sparfloxacin, Doxycycline, etc.). The recovery course includes hormonal (Divigel, Utrozhestan) and metabolic therapy (Actovegin, Riboxin, Ascorbic acid, Vitamin E).

To stop uterine bleeding, hormones are used or a solution of Aminocaproic acid is administered (intravenously or intrauterinely).

Physiotherapy plays a special role in the treatment of chronic endometritis: electrophoresis of copper, zinc, etc., pulsed ultrasound therapy and others. Such therapy relieves inflammatory swelling of the endometrium, stimulating blood circulation and immunological reactions. Patients are recommended mud therapy and hydrotherapy.

When assessing the effectiveness of treatment for a chronic form of the disease, indicators such as restoration of the endometrial structure (ultrasound data), normalization of the cycle, elimination of infection, elimination of symptoms, and normalization of reproductive function are taken into account.

Folk remedies for the treatment of acute endometritis.
Traditional medicine for the treatment of acute forms of endometritis suggests douching with infusions of medicinal herbs. For example, an infusion of marshmallow root, oak bark and mantle. This procedure effectively relieves pain. The herbs are mixed in equal proportions, then thoroughly crushed. Take a tablespoon of the resulting herbal composition and pour 200 ml of boiling water. Place the mixture on the fire and cook for fifteen minutes over low heat. Then the liquid must be left for an hour and filtered.

To relieve inflammation of the uterus, lard and turpentine are mixed in equal proportions with marshmallow color and applied to the lower abdomen.

A decoction of elm bark is also effective in the treatment of uterine inflammation; it is recommended to use it as a douche. Brew a tablespoon of crushed bark with 200 ml of boiling water, cover with a lid and place on the stove over low heat. After the mixture boils, keep it on the fire for half an hour. Then all that remains is to cool the broth and strain.

Traditional treatment of chronic endometritis.
As a local treatment for the disease, baths based on infusions of medicinal preparations are used. Pour six tablespoons of the collection (I will describe the composition below) with two liters of boiling water, put on fire and keep on low heat for fifteen minutes after boiling. Then remove the mixture from the heat and place in a warm place overnight. After three weeks, the effect of treatment is observed. Lasting results are achieved with regular and long-term use.
Herbal compositions:

• Mix 50 g each of birch leaves, cuff leaves, blueberries, tansy flowers, geranium, oak bark, chamomile and violet.
• Mix 50 g of snakeweed root, calendula, plantain, agrimony, yarrow, bird cherry fruit, and thyme.
• Mix 50 g of marshmallow root, wormwood, and aspen buds.
• Mix 50 g each of bergenia root, fireweed leaves, lavender and violet.
• Mix 50 g of viburnum bark, flax seeds, clover flowers and celandine and horsetail herbs.
• Combine 50 g of birch leaves, nettles, coltsfoot, juniper fruits, bird cherry and coriander.
• Mix 50 g each of angelica root, St. John's wort, calendula, meadowsweet, mint, dandelion root and blueberry leaves.

Endometritis during pregnancy, after childbirth.
This disease poses a danger during pregnancy. Timely diagnosis and early treatment will save the child’s life, otherwise the fetus will die as the disease progresses. Therefore, it is important to run to a gynecologist when the first signs of the disease appear.

Postpartum endometritis is a common complication after childbirth and is usually diagnosed using ultrasound. The causes of postpartum endometritis are:

• gestosis;
• long labor period, especially if the fetus has been without fluid for a long time;
• the birth of a large baby, abnormal position of the fetus;
• large fetus or its incorrect position;
• narrow pelvis (childbirth);
• old women giving birth (after thirty and if this is the first child);
• childbirth before the age of nineteen;
• premature placental abruption;
• infection of the mother with an STD;

The high-risk group includes women who have had abortions, chronic tonsillitis and pyelonephritis, as well as complications after childbirth.

Prevention of endometritis.
As a preventive measure, it is recommended to carefully observe the hygiene of the external genital organs, especially during menstruation, use protection to prevent unplanned pregnancy and, as a consequence, abortion, and use an additional condom to avoid infection with STDs. In addition, prevention of postpartum and post-abortion infections is important.

Endometritis refers to the inflammatory process in the endometrium, the inner mucous layer of the uterus. This disease is often combined with inflammation of the muscle layer of this organ - endomyometritis.

The endometrium is the inner functional lining of the uterus, which changes its structure throughout the menstrual period.

In each cycle, it matures and grows anew, preparing for the process of attachment of a fertilized egg, and is rejected if pregnancy does not occur.

Normally, the uterine cavity, which is lined by the endometrium, is reliably protected from the penetration of any infectious agents. However, under certain special conditions, the infection easily penetrates this organ and causes inflammatory reactions in its inner layer - endometritis.

Causes of endometritis

In the occurrence of this pathological condition, an important role is played by the reduction of barrier protective mechanisms that prevent the penetration of infectious agents directly into the internal genital organs.

This can be caused by many reasons, including:

• maternal birth injuries. Injuries to the cervix, vagina, and perineum during childbirth contribute to infection entering the genital tract and its further penetration into the uterine cavity;
• mechanical, chemical, thermal factors that damage the vaginal mucosa. Frequent douching, poor genital hygiene, and the use of special vaginal spermicides lead to changes in the normal microflora of the vagina and indicators of its protective properties;
• childbirth, abortion, menstruation. The release of blood can lead to the washing out of the secretions of the cervical canal, alkalization of the vaginal environment (normally it is acidic) and a decrease in its bactericidal properties. Under such conditions, various pathogenic microorganisms can easily penetrate from the external environment and then actively multiply on the wound surfaces of the uterus;
• intrauterine contraceptives. Intrauterine devices, which remain in the cavity of this organ for a long time, become a potential source of inflammatory reactions that facilitate the penetration of infection upward through the threads of this device. If endometritis occurs, it must be urgently removed;
• use of vaginal tampons. They absorb bloody secretions and therefore are an optimal environment for the development of the infectious process. Tampons should be changed every four to six hours and should not be used at night, before or after menstruation, or in hot climates. Violation of the rules of use can lead to the so-called toxic shock syndrome;
• overwork, chronic stress, poor hygiene. These factors also weaken the body and make it susceptible to infection.

Classification of endometritis

According to the nature of the course, acute and chronic forms of endometritis are distinguished. According to the etiological principle, specific and nonspecific forms of this disease are distinguished.

The disease can be nonspecific in the presence of bacterial vaginosis, HIV infection, the use of intrauterine devices, or when taking hormonal contraceptives.

The following morphological variants of chronic endometritis are also distinguished: atrophic (it is characterized by atrophy of the glands, infiltration of the mucous membrane with lymphoid elements), cystic (fibrous (connective) tissue compresses the ducts of the glands, as a result their contents thicken), hypertrophic (chronic inflammation leads to proliferation of the mucous membrane ).

The development of acute endometritis is preceded by abortion, mini-abortion or childbirth, hysteroscopy, diagnostic curettage of the uterine cavity or other intrauterine manipulations. Incomplete removal of the placenta, the remains of the fertilized egg, the accumulation of clots and liquid blood create good conditions for the development of infection and acute inflammatory processes of the inner surface of the uterus.

In the development of this disease, the state of the endocrine, immune, and nervous systems, which often aggravate its course, is of particular importance.

Acute endometritis most often develops three to four days after infection.

It is manifested by pain in the lower abdomen, discharge from the genital tract with an unpleasant odor, increased heart rate, increased temperature, painful urination, and chills.

Acute endometritis has a particularly rapid and severe course in those patients who use intrauterine devices. The first signs of this disease are a reason to immediately contact a gynecologist.

A gynecological examination may reveal a moderately painful and enlarged uterus, serous-purulent or sanguineous discharge. The acute stage lasts from one week to ten days and, with well-chosen therapy, ends with complete recovery, otherwise the disease becomes chronic.

Chronic endometritis

Chronic forms of endometritis are often the result of an untreated or inadequately treated acute form of this disease, which usually occurs after intrauterine manipulation, abortion, due to the presence of various foreign bodies of the uterus.

In eighty to ninety percent of cases, this pathological condition occurs in women of the reproductive period and has a steady upward trend, which can be explained by the widespread use of intrauterine contraception, the increase in the number of intrauterine therapeutic and diagnostic procedures, and abortions.

Chronic endometritis is the most common cause of miscarriages, infertility, failed attempts at in vitro fertilization, complications of the subsequent period, childbirth and pregnancy.

To identify infectious agents in this disease, highly accurate immunocytochemical diagnostics are used. Chronic forms of endometritis in most cases have a mild clinical course without pronounced symptoms of microbial infection.

When conducting a gynecological examination, thickening of the uterine mucosa, hemorrhages, serous plaque, and fibrous adhesions are noted, which lead to disruption of the normal functioning of the endometrium.

The severity of the chronic form of this disease is determined by the duration and depth of changes in the structure of the endometrium.

The main manifestations of chronic endometritis are changes in the menstrual cycle (heavy or scanty periods), pathological bloody or serous-purulent discharge, uterine bleeding, uterine bleeding, aching pain in the lower abdomen, painful sexual intercourse.

When conducting a two-handed gynecological examination, a slight increase in size and thickening of the uterus is determined. With this disease, changes in the structure of the endometrium can cause the formation and further growth of cysts and polyps.

Chronic endometritis causes infertility in ten percent of cases, and miscarriage in sixty percent of cases.

The muscular layer of the uterus can often be involved in the inflammatory process. The result is myoendometritis.

Postpartum endometritis

Postpartum endometritis is understood as an infectious inflammation of the inner lining of the uterus that occurs after a cesarean section (in more than twenty percent of cases) or spontaneous childbirth (in two to five percent of cases).

The main causative agents of this disease are Escherichia coli, Klebsiella, Proteus, Enterococci, Enterobacteriaceae, Peptostreptococcus, Staphylococcus, Streptococcus B.

The infection can be transmitted ascendingly (from the vagina), hematogenously (from another source of inflammation (angina, pyelonephritis), lymphogenously (through lymphatic vessels), intraamnially (with a variety of invasive interventions performed during pregnancy (cardocentesis, amniocentesis).

Risk factors for the development of postpartum endometritis include slowing down the processes of uterine involution after childbirth (return of the organ to its previous size), retention of lochia in the uterus, prolonged labor, bleeding during childbirth or in the postpartum period, a long anhydrous period (more than twelve hours from the moment of direct rupture). waters before the birth of the child), trauma to the tissues of the birth canal.

This disease is characterized by the following symptoms:

1. pain localized in the lower abdomen;
2. an increase in body temperature to thirty-eight degrees, in severe cases chills appear, this figure increases to thirty-nine degrees;
3. unpleasant odor of discharge after childbirth (lochia);
4. increased fatigue;
5. weakness;
6. increased drowsiness;
7. decreased appetite;
8. increased heart rate.

The disease usually begins on the third or fourth day after birth and lasts six to ten days.
Complications of postpartum endometritis include metritis (the inflammatory process is localized in all membranes of the uterus), parametritis (inflammation of the surrounding tissue), thrombophlebitis of the pelvic veins, peritonitis (inflammation of the peritoneum), and sepsis.

Chronic catarrhal endometritis

Chronic inflammation of the uterine mucosa, which is characterized by the constant release of catarrhal exudate from the cavity of this organ - chronic catarrhal endometritis.

Most often, this form of the disease develops from untreated forms of acute endometritis. The infectious process can spread both ascending and lymphogenous and hematogenous.

Chronic catarrhal endometritis is characterized by periodic or constant discharge of flaky cloudy mucus from the uterus. Usually there is no pain in the uterus, its contractility is either absent or weakly expressed. This disease is often the cause of infertility. With timely and adequate treatment, it usually goes away without a trace.

Purulent endometritis

Purulent endometritis is one of the most dangerous forms of endometritis and, if not treated in a timely manner, often leads to the development of infertility and miscarriages. Its cause is the accumulation of pus inside the uterine cavity, as a result of which various infectious agents (streptococcus, staphylococcus, E. coli) penetrate into it.

Very often, this form of the disease occurs after abortion or childbirth. The uterus does not contract sufficiently and its cervix becomes clogged with blood clots and remnants of placental tissue, as a result of which the outflow of its contents becomes difficult. In addition, purulent endometritis can occur as a result of the breakdown of malignant tumors.

Symptoms of this disease can be both hidden and obvious. In the latter case, an increase in body temperature is observed, pain occurs in the lower abdomen, and pathological discharge from the vagina appears. A gynecological examination reveals a painful or enlarged uterus.

If endometritis is detected early in pregnancy, it does not affect the development of the fetus.

In this case, it is necessary to carry out rational therapy and prevent further spread of the pathological process.

Detection of endometritis at a later date or a woman’s untimely visit to the doctor can cause the development of complications such as miscarriage or miscarriage.

Most likely, the pathological process in this case has spread to a significant part of the endometrium and its treatment will be long and difficult.

Therefore, it is important to contact a gynecologist in a timely manner if at least one suspicious symptom is detected and further conduct a full examination to clarify the diagnosis and select adequate therapy.

Diagnosis of endometritis

To diagnose acute endometritis, complaints and medical history are collected, all symptoms and predisposing factors are clarified. A gynecological examination is one of the most informative ways to diagnose and clarify the diagnosis of this disease. A clinical blood test and bacterioscopic examination of smears are of particular importance.

Since there is a possibility of developing severe complications of a septic nature (peritonitis, pelvioperitonitis, parametritis), women with acute forms of endometritis should be treated inpatiently.

Some women living in large cities and taking hormonal medications are at increased risk of developing uterine fibroids.

For the diagnosis of chronic forms of endometritis, in addition to clarifying the history of the disease and clinical signs, special importance is given to curettage of the uterine mucosa, which is carried out for diagnostic purposes. Histological examination of the endometrium (altered) also allows us to confirm this diagnosis. Ultrasound and hysteroscopy are also important diagnostic methods, which directly reveal structural changes in the endometrium.

In the acute phase of the disease, patients are prescribed inpatient treatment with bed rest, physical and mental rest, drinking regimen, and a nutritious, easily digestible diet.

The basis of drug therapy is antibacterial drugs, taking into account the individual sensitivity of the pathogen (ampicillin, amoxicillin, gentamicin, clindamycin, lincomycin, kanamycin and others). For mixed microbial flora, several antibiotics are prescribed. Since anaerobic pathogens are often associated with the underlying infection, metronidazole is included in the treatment regimen.

To relieve symptoms of intoxication, protein and saline solutions of up to two to two and a half liters per day are injected intravenously. The inclusion of multivitamins, immunomodulators, antihistamines, antifungals, and probiotics in the treatment regimen for acute endometritis is also advisable.

For anti-inflammatory, analgesic and hemostatic (hemostatic) purposes, cold is applied to the abdominal area (two hours - cold, then a break of thirty minutes).

When the intensity of symptoms decreases, hirudotherapy (treatment with medicinal leeches) and physiotherapy are prescribed. Therapy for chronic endometrium is based on an integrated approach, which includes immunomodulatory, antimicrobial, restorative, and physiotherapeutic treatment.

Therapy is carried out in stages. The first step is to eliminate infectious agents, then a course is carried out to help restore the endometrium.

Broad-spectrum antibacterial agents (doxycycline, sparfloxacin) are usually used.

The recovery course is based on a combination of metabolic (Riboxin, Actovegin, vitamin E, ascorbic acid, Wobenzym) and hormonal (Utrogestan plus Divigel).

Medicines must be injected directly into the uterine mucosa, which helps create their increased concentration at the site of inflammation, which ensures the highest possible therapeutic effect. To eliminate uterine bleeding, a solution of aminocaproic acid or hormonal drugs is prescribed.

Physiotherapy takes second place in the treatment of chronic endometritis. Electrophoresis of zinc, copper, iodine, lidase, UHF, magnetic therapy, and ultrasound therapy are used. Physiotherapeutic treatment reduces the severity of inflammatory edema of the endometrium, stimulates immunological reactions, and activates blood circulation. Patients with this form of the disease are indicated for resort therapy (hydrotherapy, mud therapy).

The effectiveness of therapy for chronic endometritis is assessed according to the following criteria:

Restoring the normal menstrual cycle;
- restoration of the morphological structure of the inner layer of the uterus (according to ultrasound results);
- disappearance of pathological signs (bleeding, pain);
- elimination of infection;
- restoration of reproductive function.

Complications and prevention of endometritis

Endometritis can cause complications during pregnancy (placental insufficiency, threatened miscarriage, postpartum hemorrhage), the formation of adhesions inside the uterus, endometrial cysts and polyps, and disruption of the menstrual cycle.

With this disease, the inflammatory process may involve the tubes and ovaries, peritonitis, and adhesions of the pelvic and intestinal organs may develop.

Adhesive disease often leads to infertility.

In the medical community, purulent endometritis in women is known as pyometra. The disease is one of the dangerous forms of endometritis. In case of timely treatment of purulent endometritis, it is possible to prevent infertility, miscarriage, create favorable conditions for conceiving a child and maintaining women's health. Endometritis is an inflammation of the lining of the uterus, and regardless of the form in which the disease occurs, it can seriously threaten the life and health of a woman, as well as her reproductive system.

Causes of purulent endometritis in women

The cause of purulent endometritis in women is the accumulation of pus inside the uterus, which occurs as a result of the penetration of infection into it (staphylococcus, streptococcus, E. coli). Quite often, the occurrence of purulent endometritis is caused by childbirth or abortion. Due to insufficient contraction of the uterus, the cervix becomes clogged with blood clots and remnants of placental tissue, which makes the outflow of contents difficult. In addition, pyometra can occur if a malignant tumor disintegrates.

Symptoms of purulent endometritis in women

Purulent endometritis in women can have both obvious symptoms and be characterized by the absence of any changes in well-being and health. In the case of pyometra, as a rule, there is an increase in body temperature, pain in the lower abdomen, and the appearance of vaginal discharge. During an examination by a doctor, a painful or enlarged uterus may be detected.

Examination for purulent endometritis

For purulent endometritis, the examination includes echography, which allows determining the size, wall thickness and general condition of the uterus, hysteroscopy, and probing. If there is a suspicion of cancer, diagnostic separate curettage of the cervical canal and mucous membrane is performed. In addition, hysteroscopy is necessary.

Treatment of purulent endometritis

The prescription of treatment for purulent endometritis is made based on the reasons that caused its occurrence. When purulent endometritis develops as a result of difficulty in the outflow of the contents of the uterus, the remaining blood clots and parts of the placenta are removed from it, after which the uterine cavity is washed with antiseptics. In case of suppuration of the submucosal myomatous node, surgery is necessary to avoid sepsis and peritonitis. When treating purulent endometritis in women, antibiotics, physiotherapeutic procedures, and vitamins are also prescribed. As a rule, such treatment is aimed at preventing the formation of adhesions in the uterus.

When treating purulent endometritis, emergency measures are required in the hospital, when a course of antibiotics is prescribed and intravenous infusion is performed. During treatment of endometritis, complete abstinence from sexual activity is necessary. The duration of treatment can range from 2 weeks to 3 months. But to prevent infection through the genital tract, physiological needs should be postponed until better times.

After purulent endometritis

After a woman has suffered from purulent endometritis, pregnancy is quite possible, but there is a high probability that problems will arise with conceiving and bearing a child. A pregnant woman should be provided with peace, medical supervision, and proper nutrition.

Prevention of purulent endometritis

The prevention of purulent endometritis includes taking vitamin complexes and taking measures that can prevent the patient from becoming infected during an abortion or during childbirth. In addition, prevention of purulent endometritis implies that the woman herself will take care of her health and undergo regular examinations by a gynecologist. It is thanks to this that it is possible to identify the disease at an early stage and successfully treat it.

Purulent endometritis is the most dangerous form of pathology. If left untreated, it provokes infertility in women and causes miscarriages. It develops due to the accumulation of purulent exudate in the uterus, which creates favorable conditions for the penetration and development of staphylococcal, streptococcal and other infections. Often the disease occurs after childbirth or termination of pregnancy.

Purulent endometritis, or pyometra, is a severe form of infectious inflammation of the uterine mucosa, which is always accompanied by vivid symptoms: pain, fever, deterioration in general condition due to intoxication of the body. In women, the condition develops after childbirth or abortion, when, as a result of blockage of the cervical canal, purulent exudate begins to form in the cavity.

Pyometra can cause infertility. Without timely medical care, it often leads to death.

Causes of purulent endometritis

The main cause of suppuration is the penetration of infection into the uterus in combination with injury to the endometrium due to unsuccessful gynecological intervention. Infection can also occur through sexual activity during menstruation.

The occurrence of purulent endometritis is explained by a combination of several unfavorable factors:

• introduction and activation of opportunistic and pathogenic flora;
• the presence of a nutrient medium for the proliferation of infectious agents - blood clots, fragments of the placenta or a decaying cancer tumor;
• lack of natural conditions for the discharge of exudate - weak contraction of the uterus, blockage of the cervical canal.

Predisposing factors

• Low immunity;
• STIs, infectious diseases of the gastrointestinal tract (salmonellosis, pseudomembranous colitis, enteritis);
• insufficient intimate hygiene;
• use of tampons and IUDs.

A thorough examination to identify the composition of pathogenic microflora and determine the extent of the spread of the purulent process will help to select adequate antibacterial therapy.

Symptoms

Signs of purulent endometritis differ depending on the form in which it occurs: acute or chronic.

Acute endometritis

The disease has the following pronounced symptoms:

• severe pain in the lower abdomen, radiating to the lower back;
• characteristic discharge: purulent, sometimes bloody;
• fever, chills.

The symptoms are characteristic of the acute phase of purulent-catarrhal endometritis, which is often diagnosed after birth by cesarean section (40% of women) and 2 times less often after natural delivery.

If measures are not taken within 10 days to remove pus and block microbial infection, acute endometritis enters a difficult-to-treat stage.

Chronic endometritis

In the chronic form, the inflammatory process is partially suppressed by the immune system, so the woman does not feel obvious discomfort. Failure of the menstrual cycle and discharge with an unpleasant odor are mistakenly associated with the restructuring of the body after childbirth or abortion.

Chronic endometritis can occur without any prerequisites, but more often it is a consequence of insufficient treatment of the acute form of the disease. In 10% of cases it leads to absolute infertility.

The acute phase of the disease, despite severe symptoms, is considered less dangerous. The chronic process affects the cellular structure of the endometrium, causing complications in the form of the formation of cysts and tumors. In this case, pathological changes in the structure of the uterus may not appear immediately, but after several years, for example, during the next pregnancy.

Diagnosis and treatment of purulent endometritis

Diagnostic procedures are aimed at determining the composition of the microbial environment and the stage of the disease.

What is included in the diagnosis

• survey - the clinical picture, nature and duration of symptoms are clarified (from when the discharge began, how severe the pain is, what contraceptives are used);
• examination - upon palpation, pain, enlargement of the uterus, and the presence of purulent exudate are noted;
• general clinical blood and urine tests - to confirm inflammation and bacterial infection;
• colposcopy – to assess the condition of the endometrium;
• Ultrasound of the endometrium and pelvic organs - foci of infection are identified;
• PCR analysis – the composition of the microflora is determined;
• bacterial smear culture - to determine the type of pathogen;
• biopsy - analysis for oncology.

Treatment

The main role is given to anti-inflammatory therapy. Three groups of drugs are prescribed according to individual dosage:

• antimicrobial - broad-spectrum antibiotics (for example, Amoxicillin, Metrogyl, Metronidazole);
• to reduce pain and inflammation - Ibuprofen;
• to speed up the process of endometrial restoration - hormonal agents, oral contraceptives.

To eliminate the symptoms of intoxication, the woman is given intravenous saline, and at the final stage, physiotherapy is prescribed.