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.
It seems like in this scenario parts of the products of conception stay in the uterine cavity. Consequently, 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
First of all, 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. Furthermore, associated with this is a foul smelling discharge, which requires a culture & sensitivity test for bacteria. Meanwhile, the woman often feels crampy pain in the lower mid abdomen, which originates from the uterus. Another scenario is 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 physician knows that the infection is unrelated to the IUD, but rather comes from a sexually transmitted disease (=venereal disease).
Treatment
Above all, the physician needs to treat a deteriorating infection with antibiotics; first, for more serious infections intravenously, second, for milder infections orally. At the same time the physician will ensure that there are no placental tissue or fetal parts remaining following an incomplete abortion. The following tests can assist the physician to assess the situation. First of all, abdominal ultrasound investigations and a CT or MRI scan delineate retained placental tissue or placental parts. Also, blood tests with beta-human choriogonadotropin testing, particularly when done a few days in a row can help.
Surgery can be necessary
If the titre is rising, this can assist in the determination whether or not surgery is necessary. Surgery consists of evacuating the uterine cavity of foreign material after the infection is under control. With an IUD that is in place for more than 30 days, the IUD often can stay in place and the physician treats the infection successfully. 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
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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.
