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Endometritis

Introduction

A uterine infection (=endometritis) is not as common as infection of the fallopian tubes. However, if there is an intrauterine device (=IUD) in place, the risk of endometritis is higher than without such a “foreign body” in place. Similarly infections can occur with a variety of bacteria following an incomplete abortion or following a delivery with incomplete expulsion of retained placenta.

In this scenario part of the products of conception are retained in the uterine cavity and this foreign material in the uterine cavity attracts the growth of a variety of bacteria. Common bacteria found in this context are E.coli, staphylococci, Bacteroides species, enterococci and anaerobic cocci.

Symptoms

With a post-delivery infection (physicians call this”puerperal infection”) there is a fever in the first few days after the delivery, which may abruptly take off on the 3rd day following the delivery.

Associated with this is usually a foul smelling discharge, which should be cultured for bacteria and sensitivity tests. The woman often feels crampy pain in the lower mid abdomen, which originates from the uterus. In an incomplete abortion the endometrial infection may only become symptomatic 2 weeks after the incomplete abortion. Following the insertion of an IUD, endometritis may develop in a small percentage of women within a few days. If the infection occurs more than 30 days after IUD insertion, the infection is usually not caused from the IUD, but rather from a sexually transmitted disease (=venereal disease).

Treatment

The deteriorating infection needs to be treated with antibiotics, for more serious infection intravenously, for milder infections orally. At the same time the physician will ensure that there is no retained placental tissue or fetal parts following an incomplete abortion.

Abdominal ultrasound investigations and a CT or MRI scan can assist the gynecologist in assessing the situation. Blood tests with beta-human choriogonadotropin testing, particularly when done a few days in a row and if the titre is rising, can also assist in the determination whether or not surgery is required. Surgery consists in evacuating the uterine cavity of foreign material after the infection has been contained. With an IUD that has been in place for more than 30 days, the IUD often can be left in place and the infection can successfully be treated. However, this is a decision, which will depend on the findings in a particular case and the gynecologist or general practitioner will advise you.

 

References:

1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

Last modified: October 3, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.