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Endometritis – the disease extended among women at which inflammatory process of a mucous membrane of a uterus is shown. Development of an endometritis of a uterus is connected with deterioration in functions of immune system to what, in turn conducts the constant chronic stress, diseases which passed into a chronic form, organism intoxication. Extremely negatively in this case traumatizing in the course of childbirth and abortions of a uterus and neck of uterus influences development of a disease. Doctors note that the chronic form of a disease is much more often diagnosed for women who during patrimonial process received deep and extensive ruptures of a neck of uterus. Doctors distinguish an acute and chronic endometritis.
When the disease is shown?
The endometritis develops at the woman under the influence of a number of conditions of an organism and the external reasons. The disease often affects an organism at different forms of female infertility, after treatment of not incubation of pregnancy with a hormonal or surgical method, at urogenital infections, after implementation in a cavity medical a uterus of tools, at chronic diseases. Also the endometritis often develops after the postponed Cesarean section, long and difficult delivery. The illness affects a uterus and if at the time of delivery at the woman the long anhydrous interval was observed, that is from an izlitiya of waters till the birth there passed more than 12 hours. The risk degree of developing of an illness increases also in case of polycarpous pregnancy, repeated childbirth, a hydramnion as at the same time the uterus stretches very strongly and is reduced after the delivery worse. The endometritis often develops as an effect of a heavy current of the third period of childbirth owing to what in a uterus there can be fragments of fetal membranes or a placenta. One more fact influencing development of an endometritis – the wrong approach to rules of personal hygiene.
Acute form of an endometritis
Initially the inflammation arises in a uterus as a hit effect in her cavity of an infection on the cervical channel. As a rule, penetration of bacteria happens if integrity of a barrier is broken. Such pathology often arises as an effect of abortions, both artificial, and spontaneous, a scraping of a mucous neck and a body of the womb which is carried out in the diagnostic purposes. Other intrauterine interventions can also become the inflammation reason. In particular, it is provoked sometimes by introduction of intrauterine contraceptives.
Inflammatory process is shown sharply later the interventions described above, and also after the delivery. The puerperal endometritis is considered the most often found display of an acute infection after the delivery. This disease develops more often at women who transferred Cesarean section (about 45% of such young mothers have an endometritis). Besides. The important factor promoting development of a disease after the delivery is decrease in immunity of the woman during pregnancy.
The inflammation at an acute form of an illness can take a uterus cover from muscles which adjoins to an endometria (such form of an illness is called an endomyometritis). If disease very heavy, then can be surprised a uterus wall completely (pan-metritis). Symptoms of an endometritis are shown in an acute form: the woman notes sharp increase of body temperature, a fever, pain in the bottom of a stomach. There are allocations from a genital tract: sometimes they are purulent, sometimes – is purulent - sanious. The acute endometritis, as a rule, proceeds about 8-10 days then the patient recovers. Complications arise rather seldom, but they have rather serious effects for the woman's organism. So, owing to generalization of process peritonitis, a parametritis, thrombophlebitis of veins of a small pelvis, pelvic abscesses, sepsis is shown. Sometimes inflammatory process gets a chronic or subacute form.
Diagnosis of an acute form of an endometritis
Initially at diagnosis of a disease existence in the anamnesis of the patient of the certain intrauterine interventions which are carried out recently is taken into account.
Further the doctor performs gynecologic inspection at which existence increase in a uterus, its sensitivity is defined at a palpation. At an endometritis sensitivity is noted on each side, in places where large absorbent vessels are located.
At suspicion on development of an acute form of an endometritis it is important to carry out laboratory analyses in which in blood the leukocytosis, increase in SOE, a deviation to the left is found. Also laboratory analysis of allocations from a genital tract is carried out. Research of vaginal swabbing allows to define leukocytic reaction, a condition of a vaginal epithelium, and also to estimate microflora. Sometimes specification of the diagnosis is required for what carrying out ultrasonic research, and also a diagnostic laparoscopy is appointed. Sometimes the doctor appoints also carrying out a biopsy of an endometria. Differential diagnosis at an endometritis is carried out with appendicitis, an extrauterine pregnancy, functional pelvic pains.
Chronic form of an endometritis
The chronic endometritis of a uterus is mainly shown as an effect of the wrong therapy of an acute form of an illness. Transition of an illness to a chronic stage is promoted by frequent carrying out a scraping of a mucous uterus, existence of the remains of inogrodny materials owing to suture after the delivery, introduction of intrauterine contraceptives. As the statistics testifies, about 14% of women have a chronic endometritis. The chronic endometritis is often shown against diseases of infectious character which are transmitted sexually.
The chronic inflammation develops under the influence of secondary infection. At a chronic endometritis in a mucous membrane of a uterus inflammatory consolidations which have focal character are formed. As a rule, they appear near glands, and also big blood vessels. Owing to long heavy inflammatory process gradually there is a sclerous change of vessels, fibrosis and other pathological phenomena. As a result in an organism of the woman disturbance of a course of cyclic processes is observed.
The main symptom of a chronic endometritis is the broken menstrual function. At the same time after the termination of periods at the woman who is ill a chronic form of an endometritis bloody allocations are observed. There is also small consolidation and increase in a uterus, function of ovaries decreases, and also other pathologies of a reproductive system can be shown. At the woman misbirths, and also infertility can result. Not always at a chronic endometritis change of an oospore is possible. Besides, at a chronic form of an inflammation of a mucous uterus polyps can develop over time.
Symptoms of a chronic endometritis are shown not only disturbances of a monthly cycle, but also other phenomena. The nagging pain in the bottom of a stomach is characteristic of such state, existence is purulent - serous allocations from a genital tract.
Diagnosis of a chronic form of an endometritis
As well as at an acute endometritis, initially the doctor pays attention to the anamnesis of the patient. It is important to know whether repeated intrauterine intervention, use of intrauterine contraceptives took place, whether there were spontaneous abortions. Information on infertility of the woman, on the postponed earlier acute endometritis is also important.
Physical research of the patient at which the specialist can find existence of increase and consolidation of a uterus is initially conducted. Laboratory blood analyses, microscopic examination of allocations from a genital tract are surely appointed.
For exact confirmation of the diagnosis histologic research of scraping of an endometria is conducted. It is important to carry out a diagnostic scraping in the first phase of a monthly cycle (approximately for the 8th day). Sometimes in the course of diagnosis hysteroscopy, ultrasonic inspection is also applied. It is important to differentiate a chronic form of an endometritis from some other the illnesses provoking infertility.
Complications of an endometritis
If adequate treatment of an endometritis was not undertaken timely, then the infection can gradually affect uterine tubes, and also mention deep uterine layers. Such defeat can lead to sepsis, infertility and even to become the death reason. Besides, owing to the postponed endometritis the woman can suffer from placental insufficiency, puerperal bleedings. Besides the risk of threat of abortion increases.
Treatment of an endometritis
Considering the fact that the acute endometritis develops as an effect of defeat of an organism microbic infections, the specialist surely includes a course of reception of antibiotics in complex treatment. If treatment effectively works, and the acute state was stopped, the course of therapy is supplemented with physiotherapeutic methods, also sick fortifying procedures, reception of vitamins are ordered.
For the purpose of the prevention of display of a chronic endometritis in days monthly to the patient additional reception of antibiotics is appointed. The doctor selects antibiotics individually, considering at the same time a susceptibility of the activator to them. Depending on extent of defeat of an endometria intensity of such therapy is defined.
Often doctors recommend to accept oral contraceptives throughout several menstrual cycles. Such drugs affect the woman's organism as anti-inflammatory drugs.
At treatment of a chronic endometritis antibacterial therapy is carried out if the sexually transmitted infection takes place. But at a chronic form of an illness, as a rule, an infection in an organism there is no woman any more. All disturbances at the same time have functional character. Therefore therapy is appointed, first of all, for the purpose of normalization of functions of an endometria. Cyclic reception of hormonal means, reception of immunomodulators, physical therapy is possible.
If the woman has endometria polyps, intrauterine unions, then the additional diagnostic scraping at which control by the hysteroscope practices is in that case appointed. Such cleanings procedure after which antiinflammatory therapy is carried out promotes approach of pregnancy and the subsequent normal incubation of a fruit.
Pregnancy at an endometritis
Endometritis and pregnancy – a combination which causes serious alarm in the doctor as during incubation of the child this illness exerts a negative impact on process of a course of pregnancy. If the disease is not diagnosed at an early stage, then inflammatory process, continuing to extend on fabrics, can initially affect fetal membranes, and later – and a fruit. In that case the child can die already in the woman's womb. But it is necessary to know that timely treatment of an endometritis allows to avoid so sad effects. Therefore the smallest signs and suspicions have to disturb at once future mother and to become a reason for consultation with the gynecologist. The doctor will appoint a course of treatment, considering pregnancy.
Prevention of a disease
To avoid development of an endometritis, it is important not to allow those factors which provoke emergence of an inflammation. The woman has to treat timely and correctly all infectious illnesses, diseases which are transmitted sexually, and also to see a doctor concerning complications which arise after patrimonial process. If the doctor defines that the woman is included into risk group on development of inflammatory processes in the course of childbirth and after them, then in the course of carrying out Cesarean section and after it to the patient the antibacterial drugs are administered.
After the delivery to women who are included into risk group ultrasonic research during which it is possible to find the remains of a placenta, fruit cover is surely conducted and to take measures for elimination of such situation. It is important that the woman strictly observed all recommendations of the doctor, watched personal hygiene, led the correct life. One more measure of prevention – regular strengthening of immune system by means of healthy nutrition, sports activities, reception of vitamins, a hardening.