Endometritis - Preg Med

What is Endometritis?

Endometritis is a condition characterized by inflammation of the endometrium (inner uterine lining) ^[1]. In severe cases, it may also involve the myometrium (middle uterine lining) and parametrium (fibrous tissue adjacent to the uterus). Inflammations of the endometrium and myometrium are sometimes specified as endomyometritis.

Endometritis Types

The condition can be classified into obstetric endometritis (pregnancy-related) and non-obstetric endometritis (not related to pregnancy) ^[2]. The pregnancy related inflammation often occurs after giving birth (postpartum endometritis), but can also occur during pregnancy.

It can also be divided into chronic (long term) and acute endometritis depending on the severity of the symptoms. The acute form is usually caused by various puerperal infections while the chronic form is often associated with retained placenta and other cell residues following elective abortion or childbirth ^[2].

What Causes Endometritis?

Bacteria like group B streptococcus, ureaplasma urealyticum, e coli and peptostreptococcus ascending into the uterus from the vagina ^[3]
Amniotic fluid infection occurring prior to or during labor usually in cases where the fetus has its first bowel movement (passing meconium) before delivery ^[4]
Pelvic inflammatory diseases (infections affecting the female organs) such as acute salpingitis, acute cervicitis
Retained tissues inside the uterus (small pieces of the placenta or other tissues) following a delivery or a miscarriage
Having a c-section delivery ^[5]
Anemia (may develop due to heavy blood loss during a c-section delivery)
Certain infectious conditions (bacterial vaginosis) during the early stages of pregnancy ^[6]
Medical tests and procedures (e.g. hysteroscopy and placement of intrauterine devices) for observing the insides of the uterus using certain tools that may irritate the uterus
Prolonged labor
Prolonged rupture of membranes ^[2]
Steroid medication (prescribed before a pre-term delivery for ensuring proper lung maturity of the baby)
Miscarriage or abortion (postabortal endometritis)
Fever with temperature above 100.4°F ^[7]
Lower abdominal pain ^[8]
Constipation or diarrhea
Uterine pain and tenderness ^[7]
Aching pain all over the body
Pelvic pain
Chills, headache and sweating
Foul smelling vaginal discharge
Abnormal vaginal bleeding
Making sure that the doctor uses sterilized equipments during delivery and any prenatal or postnatal surgery
Taking antibiotic medicines as a precaution before any prenatal or postnatal surgery or a c-section delivery ^[9]

What are the Risk Factors of Pregnancy-Related Endometritis?

Having a c-section delivery ^[5]
Anemia (may develop due to heavy blood loss during a c-section delivery)
Certain infectious conditions (bacterial vaginosis) during the early stages of pregnancy ^[6]
Medical tests and procedures (e.g. hysteroscopy and placement of intrauterine devices) for observing the insides of the uterus using certain tools that may irritate the uterus
Prolonged labor
Prolonged rupture of membranes ^[2]
Steroid medication (prescribed before a pre-term delivery for ensuring proper lung maturity of the baby)
Miscarriage or abortion (postabortal endometritis)

What are the Signs and Symptoms of Endometritis?

Antepartum Symptoms

Severe abdominal pain or menstrual-like cramps
Heavy periods
Fatigue

Postpartum Symptoms

Fever with temperature above 100.4°F ^[7]
Lower abdominal pain ^[8]
Constipation or diarrhea
Uterine pain and tenderness ^[7]
Aching pain all over the body
Pelvic pain
Chills, headache and sweating
Foul smelling vaginal discharge
Abnormal vaginal bleeding

How to Prevent Obstetric Endometritis?

Making sure that the doctor uses sterilized equipments during delivery and any prenatal or postnatal surgery
Taking antibiotic medicines as a precaution before any prenatal or postnatal surgery or a c-section delivery ^[9]

Endometritis Diagnosis

The doctor performs a thorough physical examination as well as a detailed pelvic exam to rule out any other pregnancy or postpartum complication ^[10]. Additional diagnostic procedures may include:

Blood tests
Vaginal ultrasounds
CT scan ^[4]
Hysteroscopy (a diagnostic procedure for assessing the uterine linings)
Tissue biopsy (collecting tissues from the uterus to be tested at a laboratory)
Cultures (collecting blood urine and vaginal discharge samples for testing)

Endometritis Differential Diagnosis

Septic pelvic thrombophlebitis
Chorioamnionitis ^[11]
Urinary Tract Infection
Pyelonephritis
Pelvic inflammatory disease

Endometritis Treatment

Mild Chronic Endometritis Treatment

Mild cases occurring after a vaginal delivery can be cured with oral antibiotics administered on an outpatient basis ^[1].

Severe Endometritis Treatment

Antibiotic medication: A combination of gentamicin and clindamycin administered intravenously ^[12] is the most common antibiotic treatment option. Certain other antibiotic medicines (e.g. cephalosporin and metronidazole) are also useful for fighting the inflammation. Antibiotics like tetracyclines and fluoroquinolones are not prescribed to pregnant and breastfeeding women.
Evacuation of retained tissues: Removal of the tissue residues using special tools while monitoring the insides of the uterus on ultrasound
Surgical intervention: In some rare cases, surgical procedures like hysterectomy may prove life-saving ^[4]. However, these are not used unless all the above treatment options fail to manage the symptoms.
Drinking lots of fluid (water, fruit juices and tea)
Getting plenty of rest
Consulting one’s doctor regarding the proper diet that can help to reduce the recovery time

Tips for Managing Endometritis at Home

Drinking lots of fluid (water, fruit juices and tea)
Getting plenty of rest
Consulting one’s doctor regarding the proper diet that can help to reduce the recovery time

Endometritis Prognosis

The symptoms of inflammation begin to subside with 48 to 72 hours of antibiotic treatment in around 90% of the cases. It is advisable to get further expert advice if the symptoms persist or continue to worsen after this period of time ^[2].

Endometritis Complications

Bacteremia (infections affecting the bloodstream) ^[7]
Septic pelvic vein thrombophlebitis (infections and thrombosis affecting the pelvic blood vessels)
Infection leading low blood pressure ^[8]
Pelvic abscess
Septic shock
Infertility

Endometritis ICD-9 and ICD-10 Codes

The ICD-9 code for endometritis is 615.9 ^[13] while its ICD-10s code is N71 ^[14].

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