What is metroendometritis: causes, symptoms, treatment and prevention. Definition and treatment of chronic metroendometritis Chronic inflammation in the stroma

Metroendometritis is an infectious gynecological disease accompanied by inflammation of the muscular layer (myometrium) and mucous membrane (endometrium) of the uterus. The disease develops against the background of penetration into the uterine cavity of infection from the fallopian tubes, vagina or cervical canal.

General statistics on the frequency of development of metroendometritis does not exist. But according to the observation of gynecologists in the postpartum period, the number of women with such a disease ranges from 3 to 8%, and with complicated childbirth it increases to 20%. Timely untreated metroendometritis can lead to a purulent-septic process, and later to uterine infertility. That is why pathology is on a par with other serious gynecological diseases.

After the infection has entered the uterine cavity, inflammation of the mucous membrane begins to develop - endometritis. The damaged mucosa eventually loses its ability to retain pathogenic microorganisms, and they begin to penetrate deeper. As a result, the infection enters the muscular layer of the uterus, causing an inflammatory disease such as metritis. At this stage, the clinical manifestations of metroendometritis become pronounced.

In a healthy woman, the uterus is reliably protected by such physiological barriers as the endometrium, uterine glands, and cervical canal. Therefore, the risk of infection entering the cavity is minimized. The development of pathology is possible with mechanical damage to the mucous membrane and with malfunctions of the immune system. That is why metroendometritis often develops after childbirth, abortion or gynecological operations.

In addition, to promote the penetration of the infection deeper, maybe self-medication. An independent attempt to get rid of the disease leads only to relief of symptoms, but not to the destruction of the source of infection.

The inflammatory process in metroendometritis can be acute, subacute and chronic. In the first case, the clinical manifestations of the disease are quite bright and appear within 3-5 days from the moment of infection. The subacute form is characterized by a more blurred clinical picture, it is more difficult to diagnose it, and most often it indicates the presence of a chronic process.

The chronic form develops when the treatment of metroendometritis was not carried out in a timely manner. Symptoms in this case are practically absent, except for the moments of exacerbation of the disease.

Causes of metroendometritis

The only reason for the development of metroendometritis in the uterine cavity is infection. In medicine, the disease is usually divided into 2 types: specific and nonspecific. In the first case, inflammation is provoked by such pathogenic microorganisms as gonococci and Trichomonas. And in the second case, the infection develops due to streptococcus, staphylococcus, Escherichia coli and a number of other microorganisms. But there are also negative factors that at some point can contribute to the development of the disease. These include:

Various injuries after diagnostic manipulations. Even a small wound in the uterine cavity can be an excellent breeding ground for bacteria.
The consequences of an abortion. During this procedure, the mucosa is removed, in place of which an open wound surface is formed. And through damaged vessels, microorganisms easily penetrate into the muscular layer of the uterus. In addition, the accumulated blood in the absence of a mucous layer becomes an ideal place for the reproduction of bacteria.
Introduction into the cavity of the intrauterine device. Microorganisms are able to penetrate through its threads.
Promiscuous sexual contacts.
Failure to comply with the rules of personal hygiene, especially in the postpartum period.
Surgical operations in the uterine cavity.
Polyps not removed in a timely manner. They delay uterine secretions, thereby forming a favorable environment for the reproduction of microorganisms.

Risk factors in the postpartum period are complicated prolonged labor, poor labor activity, uterine bleeding, and remnants of placental tissue in the uterine cavity. The development of metroendometritis can contribute to menstruation, endocervicitis and venous congestion in the pelvic organs.

Clinical manifestations of the disease

Symptoms of metroendometritis directly depend on the cause of its occurrence. But there are a number of common clinical manifestations. These include:

disruption of the menstrual cycle;
aching pain in the lower abdomen;
symptoms of intoxication of the body (nausea, vomiting).

During a gynecological examination, the doctor detects a change in the size and shape of the uterus. Pain on palpation may be present depending on the degree of inflammation.

The main symptoms of acute metroendometritis are severe pain in the pubic area, a sharp increase in temperature and the appearance of purulent discharge with a characteristic unpleasant odor. The acute form of the disease most often develops 3–5 days after intrauterine intervention (abortion, childbirth, insertion of a spiral).

The symptoms of chronic metroendometritis include uterine bleeding, severe pain with pressure in the uterus and its significant increase in size. According to the observations of gynecologists, any violation of the reproductive function in a woman can be considered an indirect clinical manifestation of the disease. For example, inability to conceive and miscarriages.

In the chronic form of the disease, menstrual dysfunctions such as anovulatory cycle and menorrhagia are often observed. Companions of chronic metroendometritis can be cysts, intrauterine synechia, adhesions in the pelvic organs and chronic.

Diagnostic methods

In order to diagnose metroendometritis, the gynecologist first of all examines the uterus and vagina. Then the doctor writes out directions for laboratory and instrumental diagnostics:

A blood test to detect leukocytes and ESR (erythrocyte sedimentation rate). Their increased number directly indicates the inflammatory process in the body.
Ultrasound (ultrasound examination).
Bakposev secretions. It allows not only to identify the causative agent of the infection, but also to determine which antibiotic in the treatment will be most effective.
The study of a vaginal smear helps to assess the severity of the inflammatory process and the microbial composition.
Transvaginal ultrasound. Using this method, you can understand the state of not only the uterus, but also other organs of the small pelvis.

Additional research methods may be needed if a patient has comorbidities. If the diagnosis of metroedometritis is difficult, then the doctor resorts to laparoscopy.

Methods of treatment

Women with suspected metroendometritis are subject to urgent hospitalization. The lack of timely treatment can provoke uterine bleeding and, as a result, death.

The basis of drug therapy in this case is antibacterial drugs. Before starting treatment, a study is carried out on the sensitivity of the pathogen to the antibiotic. If such a procedure is not possible, then the doctor prescribes broad-spectrum drugs. One of the most common antibiotics for metroendometritis is penicillin. If the drug is intolerant, at the discretion of the gynecologist, it is replaced with macrolides, tetracyclines or third-generation cephalosporins.

In any case, the doctor prescribes drugs individually for each patient, sometimes it can be a whole group of drugs. The course of treatment lasts an average of 10-14 days. To remove toxins and purulent accumulations, the uterine cavity is washed with antiseptics. Additionally, to strengthen the immune system, a vitamin complex is prescribed.

Non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin) help to stop the inflammatory process in the uterine cavity. They not only relieve pain, but also reduce tissue swelling. After stopping the inflammatory process, the patient is prescribed physiotherapeutic procedures. These include electrophoresis, phonophoresis, paraffin and laser therapy.

Remember, the resumption of sexual activity is possible not earlier than one menstrual cycle after the end of treatment. Such a precaution is necessary for the complete restoration of the endometrium, otherwise the risk of re-infection is very high.

Forecast and prevention

Prevention of metroendometritis consists of a few simple rules. The main ones include the following points:

No random connections.
Compliance with the rules of intimate hygiene, especially during the menstrual cycle.
Timely visit to the gynecologist for a preventive examination.
Competent approach to the choice of contraceptives.
Timely treat any pathology of the pelvic organs.
After the establishment of the intrauterine device and in the postpartum period, visits to the doctor should be regular.
If you experience any of these symptoms, you should immediately consult a gynecologist.

If treatment is started in a timely manner, then the chance for a complete recovery without consequences is quite large. The lack of therapy contributes to the transition of metroendometritis into a chronic form. The inflammatory process will move on, covering not only the uterus, but also neighboring organs. In this case, abscesses, thrombosis and complete infertility can hardly be avoided. That is why you should not delay visiting a gynecologist and hoping that metroendometritis will go away on its own.

Causes of metroendometritis

Various injuries after diagnostic manipulations. Even a small wound in the uterine cavity can be an excellent breeding ground for bacteria.
The consequences of an abortion. During this procedure, the mucosa is removed, in place of which an open wound surface is formed. And through damaged vessels, microorganisms easily penetrate into the muscular layer of the uterus. In addition, the accumulated blood in the absence of a mucous layer becomes an ideal place for the reproduction of bacteria.
Introduction into the cavity of the intrauterine device. Microorganisms are able to penetrate through its threads.
Promiscuous sexual contacts.
Failure to comply with the rules of personal hygiene, especially in the postpartum period.
Surgical operations in the uterine cavity.
Polyps not removed in a timely manner. They delay uterine secretions, thereby forming a favorable environment for the reproduction of microorganisms.

Risk factors in the postpartum period are complicated prolonged labor, poor labor activity, uterine bleeding, and remnants of placental tissue in the uterine cavity. The development of metroendometritis can contribute to menstruation, bacterial vaginosis, colpitis, endocervicitis and venous congestion in the pelvic organs.

Clinical manifestations of the disease

Symptoms of metroendometritis directly depend on the cause of its occurrence. But there are a number of common clinical manifestations. These include:

disruption of the menstrual cycle;
aching pain in the lower abdomen;
symptoms of intoxication of the body (nausea, vomiting).

During a gynecological examination, the doctor detects a change in the size and shape of the uterus. Pain on palpation may be present depending on the degree of inflammation.

Diagnostic methods

In order to diagnose metroendometritis, the gynecologist first of all examines the uterus and vagina. Then the doctor writes out directions for laboratory and instrumental diagnostics:

A blood test to detect leukocytes and ESR (erythrocyte sedimentation rate). Their increased number directly indicates the inflammatory process in the body.
Ultrasound (ultrasound examination).
Bakposev secretions. It allows not only to identify the causative agent of the infection, but also to determine which antibiotic in the treatment will be most effective.
The study of a vaginal smear helps to assess the severity of the inflammatory process and the microbial composition.
Transvaginal ultrasound. Using this method, you can understand the state of not only the uterus, but also other organs of the small pelvis.

Additional research methods may be needed if a patient has comorbidities. If the diagnosis of metroedometritis is difficult, then the doctor resorts to laparoscopy.

Methods of treatment

Women with suspected metroendometritis are subject to urgent hospitalization. The lack of timely treatment can provoke uterine bleeding and, as a result, death.

Forecast and prevention

Prevention of metroendometritis consists of a few simple rules. The main ones include the following points:

No random connections.
Compliance with the rules of intimate hygiene, especially during the menstrual cycle.
Timely visit to the gynecologist for a preventive examination.
Competent approach to the choice of contraceptives.
Timely treat any pathology of the pelvic organs.
After the establishment of the intrauterine device and in the postpartum period, visits to the doctor should be regular.
If you experience any of these symptoms, you should immediately consult a gynecologist.

Content

Metroendometritis is an infectious-inflammatory complex disease in which the mucous membrane of the uterus (endometrium) and its muscular layer are affected. The course of the disease is possible in three main forms: acute, subacute and chronic, each of which has its own symptoms and requires different methods of treatment.

The progression of the disease and the lack of therapy often leads to complete infertility, problems with conception and regular miscarriages. In order to avoid the occurrence of serious complications, it is extremely important to pay attention to the existing symptoms in a timely manner and start treatment.

Acute form of metroendometritis

Symptoms of the acute phase appear at the very beginning of the disease and usually last no longer than one week. The main signs boil down to:

increase in body temperature;
apathy and weakness;
chills
increased fatigue;
pain in the lower abdomen;
possibly increased heart rate and nausea.

Body temperature in the acute course of the disease can reach 39 degrees, and severe pain can spread to the area of the sacrum and inguinal zone. During this period, a woman experiences unbearable pain in the uterus, her swelling appears, and the pain increases sharply with palpation of the organ. In the process of complete rejection of the mucous layer of the endometrium, it disintegrates, and the inflammatory process spreads to the muscle layer, lymph nodes and blood vessels.

Complications that appeared in the acute phase of metroendometritis, can lead to uterine sepsis, which is extremely dangerous not only for health, but also for the life of the patient.

subacute

The main symptoms in the subacute stage of the disease are bloody, purulent and mucous copious discharge. Pus in the subacute form is released less intensively than in the acute phase. It is at this stage that the symptoms of the disease can proceed quite imperceptibly and develop into a chronic form, the treatment of which is much more difficult and lengthy.

Pain in the abdomen with a subacute form is less intense and is characterized mainly as pulling and unpleasant, but can also spread to the lumbar region and groin. Another characteristic symptom of the subacute stage is prolonged and profuse menstruation, in some cases even menorrhagia can be observed. With a particularly intense course, inflammatory processes contribute to the destruction of myometrial tissues, which leads to their replacement with connective fibers.

Chronic

It is the most common type of disease, the symptoms of which are especially characteristic of postmenopausal women. The chronic form of metroendometritis, as well as its acute form, contributes to the destruction of the mucous membrane in the uterine cavity and the spread of lesions to muscle tissue. The neglected stages contribute to the appearance of complications and the spread of infectious processes to the peritoneum and pelvic vessels. It is also possible the formation of more severe complications, such as sepsis and incessant bleeding.

Symptoms of the disease

The most common symptoms of any form of metroendometritis are:

mucous, bloody and purulent vaginal discharge;
an increase in body temperature (in acute and subacute form, it can reach 39 degrees, chronic causes a constant subfebrile temperature - up to 37.8 degrees);
various kinds of disturbances in the menstrual cycle (intercyclic bleeding, prolonged heavy or, on the contrary, too meager periods, cycle failure);
leukocytosis, leading to weakness, difficulty breathing, increased sweating, pain in the limbs;
increase in ESR (erythrocyte sedimentation rate);
difficulties in the process of conception, regular miscarriages, infertility.

Reasons for the appearance

Causes of acute and subacute appearance

The process of infection occurs due to the entry into the uterine cavity of pathogens, fungi or bacteria. Most often, pathogenic microorganisms such as streptococci, gonococci, staphylococci, as well as E. coli, etc. provoke the disease. hygiene.

Often the cause of metroendometritis It can also be a common cold or flu.

Symptoms of acute or subacute metroendometritis may appear several days after childbirth. Indeed, in the process of labor activity, the uterine cavity remains completely unprotected for various kinds of infections. It should be noted that after a caesarean section, the risk of infection is much higher than during natural childbirth.

Reasons for education

Most often, the symptoms of the chronic stage of the disease appear as a result of an untreated acute form. Much less often it is noted as an independent disease. Often, the chronic form of the disease is the result of the activity of bacterial infections, for example, chlamydia and other harmful sexually transmitted bacteria.

As in the case of acute metroendometritis, various gynecological procedures and operations can become the cause of the chronic form: abortion, hysteroscopy, removal of tumors or polyps.

The main risk factors include:

installation of intrauterine devices;
pregnancy (during the bearing of the fetus, sharp hormonal disorders occur, and the work of the immune system decreases);
diagnostic curettage and probing;
unprotected intercourse;
self douching;
use of tampons;
early onset of sexual activity after childbirth.

Although the infection occurs as a result of ingestion of harmful bacteria and microorganisms, the development of the disease usually occurs against the background of reduced immunity and disturbances in the protective functions of the body.

Treatment

Those patients who have acute metroendometritis or if it occurs immediately after childbirth are subject to mandatory hospitalization. Lack of adequate treatment during this period can cause complications such as sepsis and uterine bleeding, which in the most severe cases are fatal.

If metroendometritis appeared as a result of a miscarriage, a course of intrauterine antiseptic lavage is mandatory. They allow you to clean the uterine cavity from blood clots, reduce the symptoms of inflammation and eliminate the process of reproduction of pathogenic microorganisms.

Medical therapy

The main treatment of such a disease involves:

broad-spectrum antibiotics;
antimicrobial agents;
analgesics that relieve pain;
sulfonamides.

With heavy uterine bleeding, ascorbic acid and vasoconstrictor drugs are additionally prescribed. Hormonal disorders are eliminated by a course of corticosteroid medications.

The chronic form of the disease is treated comprehensively. In addition to the mandatory drug therapy, physiotherapeutic procedures are also prescribed: mud therapy, hirudotherapy, sanatorium treatment, electrophoresis, light therapy and much more.

The use of folk methods

The use of some folk recipes can really alleviate the patient's condition, remove the main symptoms and speed up the recovery process. But it should be noted that such treatment should be complex, combined with conservative methods and selected together with a phytotherapeutist.

Self-treatment with folk remedies is strictly prohibited, since incorrectly chosen methods can worsen the condition and lead to serious complications.

independent douching with solutions of sage, chamomile, nettle or linden flowers;
drinking medicinal decoctions and tinctures from the collection of herbs;
sitz baths with the addition of herbs with anti-inflammatory and soothing effects.

Treatment of metroendometritis during pregnancy

Undoubtedly, a disease diagnosed during pregnancy can have a very negative impact on the development of the fetus and the course of pregnancy in general. Complications that are possible with the development of metroendometritis during the period of bearing a child are premature birth, dysfunction, difficulty in the activity of the placenta, intrauterine hypoxia, and fetal growth retardation.

Since most of the drugs that are used in the treatment of this disease are strong enough and can harm the child, therapy is not used with a sluggish form of the disease. Pregnant women are on a special account with a specialist, and treatment is carried out already in the period after delivery. However, the presence of metroendometritis has no effect on the birth process itself.

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Metroendometritis is a common disease in gynecological practice. It affects all women, regardless of age. It is presented in the form of inflammation of the mucous membrane and the muscular layer of the uterine cavity, which develops as a result of exposure to provoking factors: infection, trauma and hormonal imbalance. Detailed information about developing metroendometritis, what it is, can be given by a gynecologist after a gynecological examination and a set of diagnostic measures.

Etiology of the disease

Metroendometritis is considered as an independent disease that develops as an inflammatory process as a result of infection with pathogenic or opportunistic flora, when the body cannot fight back due to a lack of the immune system. Infection with pathogenic microorganisms is not the only reason for the development of the disease. In some cases, this circumstance is preceded by a change in hormonal levels. Homon imbalance becomes a trigger for the emergence of conditions favorable for the development of a pathological process in the uterine cavity.

In addition to the immune status, the uterine cavity is protected by physiological barriers. Due to the cyclic rejection of the inner layer of the uterus, its mucous membrane is constantly updated, which helps prevent the penetration of pathogenic microorganisms. Prevents the penetration of infection into the uterine cavity and mucus produced by the glands of the cervical canal. It is so thick that it is difficult for germs to penetrate into the upstream area. The natural protective functions of the body are quite enough to prevent infection and the development of the inflammatory process. However, a sufficient immune status is observed in the absence of a weak link - damage in the internal layers of the organ.

The doctor can diagnose the disease during a bimanual examination after the presentation of complaints by the patient. A complex of additional laboratory and instrumental methods for studying the body and, in particular, the reproductive sphere will allow us to assume with maximum confidence the form of the disease and the causes that contribute to its occurrence. In the course of a diagnostic study of the uterine cavity, structural changes in its layers are observed in the form of compaction, proliferation of the epithelium, hyperemia of the muscle layer, and mucopurulent discharge.

There are 3 stages of the disease:

Acute stage. It is characterized by an acute onset of the inflammatory process in the form of an increase in body temperature to febrile levels (38-40 degrees), pain of varying intensity in the lower abdomen, unnatural discharge with purulent contents and an unpleasant odor. Often there are signs of general intoxication of the body in the form of nausea, vomiting, impaired consciousness.
Subacute stage. It is characterized by an intermediate state, when acute inflammation subsides, but is not completely eliminated. Erased symptoms of the disease contribute to self-treatment and the transition of the disease into a chronic form.
chronic stage. Asymptomatic or characterized by vague pain in the lower abdomen and the projection of the sacrum. If metroendometritis is not diagnosed in time and not completely treated, the residual effects of inflammation provoke relapses of the disease. Treatment in this case is somewhat different from the standard scheme. Chronic inflammation is much more difficult to eliminate. Therefore, it is so important to diagnose metroendometritis at an early stage of development.

Causes contributing to the development of metroendometritis

The infectious nature of the origin of metroendometritis contributes to its occurrence in damaged areas of the uterus.

Metroendometritis provides for the following causes:

Signs of developing metroendometritis

Depending on the form of the disease, the time of diagnosis, the state of the immune system, the signs may be individual in each case. However, the main symptoms of the disease in the acute form of pathology are the following:

severe pain in the lower abdomen, in the lumbar region, radiating to the rectum;
soreness of the uterus during its palpation;
bloating;
purulent discharge from the vagina;
violation of the general condition with the phenomena of intoxication.

An instrumental examination reveals:

hyperemia, puffiness, compaction and loosening of the inner layer;
the presence of a pronounced vascular network on the mucous membrane;
foci of tissue necrosis with the release of purulent contents;
pathological vaginal discharge mixed with blood and pus;
high levels of leukocytes and ESR in a clinical blood test;

From the moment the first characteristic symptoms appear after a violation of the uterine mucosa, a woman needs urgent hospitalization in the gynecological department. Self-medication in this case is unacceptable.

The risk of sepsis is increasing every day. With erased symptoms, women neglect this rule. The disease becomes chronic and recurs over many years.

Despite the similarity of these signs with other gynecological diseases, the basis for the diagnosis is the presence of structural damage in the layers of the uterus.

Treatment and prevention

Treatment of metroendometritis is carried out after the previous set of diagnostic measures using laboratory and instrumental methods of examination. The emphasis is on identifying the causative agent of the disease. Based on the test results, the gynecologist prescribes further therapy, adjusting it throughout the course of treatment.

The standard treatment regimen for metroendometritis includes the following procedures:

The lack of proper treatment threatens the development of complications. These include the following events:

violation of the menstrual cycle (prolongation of the period, change in the nature of the discharge);
the transition of the disease to a chronic form with subsequent relapses;
the appearance of intermenstrual bleeding;
adhesive processes in the pelvic organs;
the formation of polyps and naboth cysts;
salpingo-oophoritis;
peritonitis (pelvioperitonitis);
sepsis;
miscarriage;
infertility.

In order to prevent the occurrence of metroendometritis or its transition to a chronic form, it is necessary to adhere to the following recommendations:

timely treatment of systemic diseases;
treatment and prevention of sexually transmitted diseases;
lack of casual sex;
complete hygiene of the genital organs;
no abortions;
regular visits to the gynecologist;
a complete balanced diet;
a healthy lifestyle and the absence of bad habits;
rational use of hormonal contraceptives.

Traditional medicine

Non-traditional methods of treatment involve the use of herbal infusions from medicinal plants with natural antiseptic, anti-inflammatory and regenerating properties. They are used for oral administration and douching:

Calendula tincture has antiseptic and regenerating properties. It is added to the water for vaginal douching (1 tsp of tincture per 0.5 l of boiled water). Tincture can be purchased at a pharmacy or prepared independently. To do this, you need to insist 1 tbsp. a spoonful of dried calendula flowers in 100 ml of medical alcohol for a week. Douching in the morning and evening for 2 weeks.
Hypericum perforatum has natural antibacterial properties. A decoction prepared from this plant (2 tablespoons of raw materials per 0.5 l of water) is taken three times a day, 3 tbsp. spoons and used for douching.
Oak bark has similar characteristics. A decoction is prepared from it in a similar way.
Plantain has hemostatic and anti-inflammatory properties. 1 st. a spoonful of dry raw materials is brewed in 250 ml of water. A decoction infused for 40 minutes, take 1-2 tbsp. spoons 3 times a day.
Viburnum berries reduce the amount of menstrual flow. They can be taken fresh or cooked berry juice. Take 3 times a day instead of tea. A strawberry leaf and nettle have a similar effect. 1 st. a spoonful of dry raw materials is brewed in a glass of boiling water and infused for 40 minutes. Take half a glass in the morning and evening for 2 weeks.
For douching, you can use decoctions from plants such as chamomile, upland uterus, yarrow, walnut leaves, willow bark, celandine. 1 st. a spoonful of raw materials is brewed in 0.5 liters of water, boiled and infused for 1 hour. Phytocompositions from the listed plants can be used. Douching should be done within 2-3 weeks.

Any decision made is agreed with the attending physician.

Timely diagnosis of the disease, a competent approach and adequate therapy contribute to the rapid elimination of the pathological process and the prevention of its transition to a chronic form. The lack of full-fledged treatment threatens not only with a complete loss of reproductive function, but also poses a real threat to life.

Metroendometritis is an inflammation of the mucous membrane (endometritis) and muscular (myometritis) of the body of the uterus. The disease occurs as a result of penetration into the uterus of a septic infection (strepto-, staphylococci, gonococci, Escherichia coli) and some other microorganisms in the hematogenous, lymphogenous or ascending way.

Course and symptoms. Most often, metroendometritis occurs on the 3-4th day after childbirth or abortion. The development of infection is facilitated by the presence in the uterus of blood clots or remnants of placental tissue. The disease begins with an increase in temperature to 38-38.5 ° and chills. The pulse is quickened, corresponds to the temperature. Patients complain of weakness, pain in the lower abdomen, headache, loss of appetite. When palpation of the uterus through the anterior abdominal wall, there is a slowdown in its reverse development (subinvolution). The uterus in acute metroendometritis is soft, swollen and painful on palpation in the lateral sections. The discharge becomes cloudy and often acquires a putrid odor. Sometimes the inflammatory process extends to all layers of the uterus (metritis), appendages and peritoneum (see Pelvioperitonitis). When antibiotics are used, the clinical picture of acute metroendometritis may be blurred.

Chronic metroendometritis is characterized mainly by purulent liquid secretions and menstrual dysfunction in the form of cyclic bleeding - menorrhagia (see Menstrual cycle). The uterus is enlarged, dense, painless.

Symptoms of gonorrheal metroendometritis (acute and chronic) are combined with other characteristic manifestations of this infection (see Gonorrhea).

With metroendometritis of tuberculous etiology, the mucous membrane of the tubes and uterus (endometritis) is predominantly affected. The leading symptom of tuberculous endometritis is infertility and menstrual dysfunction (bleeding, amenorrhea). Decisive in the diagnosis of tuberculous endometritis are the data of histological examination of endometrial scrapings.

Treatment. Patients with metroendometritis are subject to hospitalization. In the acute stage of the disease, bed rest, cold on the lower abdomen, antibiotics, painkillers are prescribed. For bleeding - ergot preparations. cotarnine chloride (stipticin), pituitrin. calcium chloride. ascorbic acid, vikasol. In chronic metroendometritis, various types of physiotherapy are indicated (diathermy, mud therapy, paraffin, ozokerite, etc.). In cases of tuberculous endometritis, specific therapy is prescribed (streptomycin, PASK, ftivazid, etc.).

Metroendometritis (metroendometritis; from Greek metra - uterus and endon - inside) - inflammation of the body of the uterus. If the inflammatory process is localized only within the mucous membrane of the body of the uterus, it is called "endometritis". The term "metritis", or "myometritis", refers to inflammation of the muscular membrane of the uterus. Metritis is usually preceded by endometritis.

Etiology. The cause of metroendometritis is often an infection. The causative agents are streptococci, staphylococci, E. coli, some anaerobes, tuberculosis and diphtheria bacilli, pale treponema, radiant fungus, etc. Metroendometritis can be observed in a number of acute infectious diseases (flu, tonsillitis, scarlet fever, measles, typhoid, etc.). The development of infection in the uterus is facilitated by prolonged and frequent circulatory disorders, for example, long-term congestion in the small pelvis that occurs with incorrect positions of the uterus, tumors of the pelvic organs, masturbation, unfinished sexual intercourse, etc.

Most often, metroendometritis develops when the infection spreads to the uterus during abortion, childbirth and menstruation, as well as when performing diagnostic and therapeutic procedures, if the rules of asepsis and antisepsis are violated. The inflammatory process can pass to the uterus from the fallopian tubes (if they are affected by tuberculosis), from the appendix and from the intestines. There are cases of inflammation of the uterus of a metastatic nature (tonsillitis, influenza, other acute infectious diseases).

Rice. 1. Acute endometritis: periglandular polynuclear infiltration.

Rice. 2. Fibroblastic transformation of the endometrial stroma in chronic endometritis (high magnification).

pathological anatomy. Inflammatory processes in the uterus often begin with the mucous membrane. In acute inflammation, the uterine mucosa thickens, and acute hyperplasia, tissue edema, and polynuclear infiltration are observed (Fig. 1). Due to edema, the stroma of the endometrium becomes filamentous, with pronounced hyperemia, extravasation may occur. The glands of the endometrium are compressed due to edema and infiltration of the stroma. Purulent tissue fusion occurs rarely. Subsequently, lymphocytes join the polynuclear infiltrate, and plasma cells appear even later.

In chronic metroendometritis, fibroblastic transformation of the connective interglandular tissue is observed in the stroma of the uterus (Fig. 2), irregularities and small polyposis formations appear on the surface of the uterine mucosa.

In some cases, there is an ingrowth of the glands into the underlying muscular membrane - there is an internal endometriosis of the uterus. With severe flow

forms of chronic endometritis, there may be violations of cyclic changes in the uterine mucosa, despite the normal function of the ovaries.

With puerperal endometritis, the inflammatory process captures the falling off membrane and the adjacent layer of the muscular wall of the uterus. The surface layers of the falling off membrane become necrotic, and an inflammatory infiltrate of polynuclear cells and lymphocytes is organized in the underlying layer. In the muscle of the uterus, swelling, expansion and thrombosis of blood vessels are observed (see Metrothrombophlebitis). The greatest danger of further spread of infection is the inflammatory process of the uterus in the area of the placental site.

As a result of severe postpartum metroendometritis, endometrial atrophy sometimes occurs.

After the formation of granulation tissue, cicatricial changes can develop in the mucous and muscular layers of the uterus.

Course and symptoms. Acute metroendometritis is accompanied by a general reaction of the body: fever, malaise, poor health, pain in the lower abdomen, often radiating to the sacrum. On palpation, the uterus is soft, edematous, enlarged, painful; profuse purulent discharge flows from the cervical canal. Chronic metroendometritis is characterized mainly by purulent liquid secretions and menstrual dysfunction. The uterus is often enlarged, dense, painless. Violation of menstrual function is more often observed in the form of cyclic bleeding - menorrhagia.

Postpartum metroendometritis manifests itself more often on the 3-4th day after childbirth: the temperature rises (38.5-39.5 °), chilling is observed, sometimes chills, and the pulse quickens. Patients complain of general weakness, headache, poor sleep and appetite. The examination reveals subinvolution of the uterus, sensitivity to palpation; when palpated, soreness is often noted in the lateral sections of the uterus. Lochia (see. Postpartum period) is not bloody or bloody-serous, but cloudy, sometimes with a putrid odor, in the future they become bloody-purulent or purulent. With a delay in the outflow of discharge from the uterine cavity, a lochiometer can be observed with an increase in temperature, an increase in the phenomena of intoxication and the appearance of cramping pains. Postpartum M. lasts 8-10 days. The temperature at high numbers with remissions up to 1 ° lasts 5-7 days, and later becomes subfebrile. If the process continues for more than 10 days, this usually indicates the spread of infection beyond the inner surface of the uterus.

Sometimes with metroendometritis, especially in old women, with narrowing of the cervical canal and its cicatricial changes, pus accumulates in the uterine cavity, pyometra occurs, which is clinically manifested by high fever, cramping pains and an increase in the uterus, which has an elastic consistency. Pyometra may be seen in uterine cancer; at suspicion on a cancer after passing of the acute phenomena test curettage is made (see).

Diagnosis metroendometritis in the acute stage is not particularly difficult. It is based on anamnesis data (delivery, miscarriage, the possibility of infection with gonorrhea, intrauterine interventions, etc.) and on the results of a general and gynecological examination (fever, soreness of the uterus, purulent discharge). The diagnosis in a chronic stage of M. is more difficult. At gynecological examination, an enlarged, dense, painless uterus, pronounced discharge are determined. Chronic inflammation of the uterus may be accompanied by heaviness and pressure in the pelvic region, pain in the lower back and sacrum. These symptoms are not pathognomonic for M., as they are also observed in other gynecological diseases.

For the diagnosis of M., laboratory data are used: changes in the blood picture during acute processes, bacterioscopic and bacteriological determination of the nature of the pathogen in an infectious disease. It should be borne in mind that with gonococcal postpartum M., gonococci are found in the discharge from the uterine cavity already on the 3-4th day after childbirth. It is especially important because gonococcal M. often proceeds as an easy disease; the temperature rises approximately on the 6-8th day of the postpartum period. In chronic M., the nature of the lesion is determined by a histological examination of the scraping obtained by scraping the uterus.

An enlarged, fibrous uterus in chronic metritis may give rise to suspicion of uterine fibroids or pregnancy. The dense, unchanging consistency of the body of the uterus, the absence of softening of its isthmus and other signs characteristic of pregnancy make it possible to exclude the latter. For uterine fibroids, it is more typical not to have a diffuse increase, but a tuberous irregular shape of the uterus with separate nodes. With metroendometritis, the cervix and appendages are usually involved in the inflammatory process.

Forecast at acute M. in most cases favorable. But in some patients, acute M. becomes chronic with a long course of the disease. Chronic M. affect the development of the fetal egg and the contractile function of the uterus (miscarriage, premature birth, anomalies of placental attachment, weakness of labor, subinvolution of the uterus in the postpartum period).

Acute postpartum M. is often complicated by the transition of the infection to the surrounding tissues and organs, and even sepsis. The course and character of M. depend on the virulence of microorganisms and the resistance of the patient's organism. Based on the foregoing, the prognosis for postpartum M. should always be made with some caution.

Treatment. In acute metroendometritis - rest, bed rest, cold on the lower abdomen, antibiotics and sulfa drugs. For pain - suppositories with belladonna or pantopon, amidopyrine. The external genitalia and perineum are washed at least twice a day with a warm disinfectant solution. Of great importance are good care, cleanliness of the skin, linen, air, regular bowel and bladder function, a balanced diet rich in vitamins. Everyday monitoring is necessary, especially in severely flowing M. (state of the heart, lungs, kidneys, liver).

In chronic metroendometritis, physiotherapeutic treatment is indicated - ionogalvanization with calcium chloride or potassium iodide, mud therapy, diathermy, paraffin and ozokerite therapy. Mud treatment, as well as hydrogen sulfide baths and irrigation, it is advisable to prescribe for the treatment of chronic M. in resort conditions. When bleeding, hemostatic agents are indicated - ergot preparations, cotarnine chloride (stipticin), etc., as well as calcium chloride, ascorbic acid, vikasol; with prolonged bleeding and anemia - blood transfusions of 100-150 ml. When the inflammatory process is combined with ovarian dysfunction, hormonal drugs are used (see Menstrual cycle, disorders, Metropathy). For diagnostic and therapeutic purposes, in the absence of contraindications, curettage is recommended (see). Curettage during post-abortion M. and retention of parts of the fetal egg in the uterus is performed if the infection has not spread beyond the uterus (see Abortion). With pyometra, it is necessary to empty the uterine cavity from pus by expanding the cervical canal.