Endometritis after childbirth: causes, symptoms, diagnosis, treatment

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

The inner layer of the reproductive organ is covered with endometrium. Endometritis is an inflammatory process of this layer. A large number of women face this pathology. It can be provoked by intrauterine diagnostic studies, abortions, but most often endometritis is diagnosed after childbirth.

The function of the endometrium is the creation of certain conditions for attaching a fetal egg to the uterus. Through the vessels of the endometrium, the unborn baby receives oxygen. Therefore, it is very important that this layer recover without consequences after childbirth.

What is endometritis?

Endometritis after childbirth negatively affects subsequent pregnancies, because for the normal bearing of a child it is very important that the mucous membrane is full.

During the menstrual cycle, the endometrium changes, resulting in optimal conditions for pregnancy. If pregnancy does not occur, the endometrial layer is shed (excreted with menstruation), leavingonly the growth layer. After the end of menstruation, the cells of the germ layer begin to divide, and the endometrium is again ready to receive a fertilized egg.

If after childbirth the reproductive organ becomes inflamed, then all the processes that occur in it are violated. A woman may develop various complications in the next attempts to conceive.

If we turn to statistics, endometritis occurs in 2-4% of women in labor, and after a caesarean section, the risk of developing pathology is even higher - 10-20%.

Etiology of the phenomenon

After childbirth, the intrauterine cavity is an open bleeding wound. Epithelial cells restore the inner layer of the genital organ after about a month and a half. Until then, the risk of infection is very high. The causative agents of the inflammatory process are constantly present in the body of a woman, but they begin to actively multiply only under certain conditions. Childbirth is just the conditions under which the pathogenic flora becomes active.

The causes of endometritis after childbirth are different, but most often doctors distinguish the following:

1. Decrease in woman's immunity. The last weeks of pregnancy and some time after childbirth, the woman's immunity is not in the best condition, therefore, it is difficult for the body to fight the infection on its own. Restoring the previous level of immunity takes several days - from 5 to 10, depending on the method of delivery.
2. Surgical intervention in the reproductive organ. In addition to the fact that immunity decreases, the surgical incision is subject to primary infection. Aftersurgery, the uterus contracts worse, which means that self-cleaning is almost impossible, which increases the risk of developing endometritis of the uterus after childbirth.

Also contribute to the development of pathology:

1. Chronic foci of infection in the body.
2. Inflammatory processes of internal organs.
3. Endocrine ailments and metabolic disorders.
4. Injury to the endometrium, which was provoked by prolonged use of intrauterine contraceptives, miscarriages, abortions or diagnostic curettage prior to pregnancy.
5. Complications during childbearing. Polyhydramnios, the threat of miscarriage, exacerbation of chronic diseases, isthmic-cervical insufficiency, acute infections, placenta previa - all this can give impetus to the development of endometritis after childbirth. In addition, invasive diagnostics, as well as suturing the cervix, can also provoke this ailment.
6. Complications during childbirth. Protracted labor, long anhydrous period, profuse blood loss, manual separation of the placenta and afterbirth, and so on.
7. The birth of a baby infected in utero.
8. Difficulties in the postpartum period. The causes of endometritis after childbirth may lie in violation of the rules of postpartum hygiene, too long bed rest, poor involution of the reproductive organ.

I must say that each individual factor cannot lead to endometritis, but in their totality, the likelihood of developing the disease increases.

Signs of postpartum endometritis

In the female body, endometritis after childbirth can occur in acute or chronic form. The clinical picture varies depending on the form of the disease. Acute endometritis after childbirth is accompanied by vivid signs, which allows timely diagnosis and treatment of the pathological process. In the chronic form, the symptoms are blurred and mild. Often women do not attach importance to such symptoms, writing it off for the postpartum period, thereby delaying the visit to the gynecologist. Such neglect can lead to irreversible consequences.

In addition, the signs of endometritis after childbirth directly depend on the severity of the disease.

With a mild course, symptoms begin to appear in the first week after delivery.

In this case, the endometritis after childbirth will have the following symptoms:

• increased body temperature;
• tachycardia;
• an increase in the size of the uterus, pain in the localization of the lymph nodes;
• prolonged spotting;
• sometimes secretions accumulate in the cavity of the reproductive organ.

Severe form of the disease begins to manifest itself clinically in the first 2-3 days after birth. Most often, a severe course of the disease is observed after a difficult birth or operation.

In this case, the endometritis after childbirth will have the following symptoms:

• purulent-resorptive fever;
• pain in the uterus;
• pus in lochia;
• discharge passes from uterus to pyometra;
• anemia.

In addition, the symptoms of endometritis in women after childbirth are manifested in the deterioration of the general condition:

• weakness;
• headaches;
• loss of appetite;
• insomnia;
• pain in the lower abdomen.

Endometritis after caesarean section

Symptoms and treatment of endometritis after childbirth depend on the mode of delivery. Surgical removal of the baby is accompanied by circumstances that do not occur during natural childbirth:

1. To extract the baby, the wall of the uterus is cut, which greatly facilitates the path of infectious agents to the uterine mucosa. In addition, if the suture becomes infected, the infection can spread to other layers of the reproductive organ, so the course of endometritis after cesarean is quite severe.
2. The suture material used by doctors can be rejected by the woman's body, and the presence of a suture impairs uterine contractions, which leads to the fact that lochia lingers in the cavity and becomes a breeding ground for bacteria.
3. After a caesarean section, a woman has a glucocorticosteroid deficiency, which significantly reduces the immune defense. Also, a woman synthesizes histamine in large quantities, causing an intracellular conflict, which also impairs the body's ability to resist infection.

A woman has a risk of developing endometritis with any method of delivery, but after a caesarean it is the highest:

1. The body becomes more vulnerable due to reduced activityprotective forces.
2. A woman has pathologies that forced doctors to perform a caesarean section - diabetes, kidney problems, metabolic disorders and so on.
3. In the process of giving birth, the woman lost a lot of blood.
4. Polyhydramnios.
5. Neglect of septic and antiseptic rules by medical workers during surgery and in the postoperative period.

Acute endometritis

As already mentioned, the symptoms and treatment of endometritis in women after childbirth depend on the form of pathology.

In acute endometritis, a woman complains of the following symptoms:

• very high temperature - up to 39 degrees;
• pain in the lower abdomen, which may radiate to the sacrum;
• blood-purulent, serous or serous-purulent discharge;
• general weakness and weakness.

It is very important to pay attention to the discharge. Normally, after childbirth, spotting can be observed for a couple of days, then their number gradually decreases, they become brown or yellowish. By about the eighth week, all discharges completely stop. Acute endometritis is accompanied by copious discharge, and in the presence of pus, they can turn green.

Chronic endometritis

Chronic endometritis after childbirth is accompanied by:

• non-falling temperature;
• periodic uterine bleeding;
• discharges that have a putrid odor;
• pain during defecation.

Diagnostic measures

Treatment of postpartum endometritis should begin after a thorough diagnosis:

1. Questioning the patient about symptoms and complaints, as well as collecting information about past infectious diseases.
2. General examination - measurement of pulse, temperature and blood pressure, as well as palpation of the uterus.
3. Examination of the cervix in the gynecological chair.
4. Palpation of the uterus to determine its size and degree of pain.
5. Ultrasound of the uterus - provides information about the presence of placental tissues and blood clots in the reproductive organ, and also indicates its exact size.
6. Laboratory tests - blood, smear, bacterial culture.

Principles of treatment

Treatment of postpartum endometritis can be conservative or surgical.

If a woman has not yet been discharged from the maternity hospital at the time of the onset of the disease, she is transferred to a special department where women who have experienced certain postpartum complications are observed. If a woman has found signs of endometritis already at home, she should be hospitalized in the gynecology department.

The main conservative treatment of pathology is the use of antibacterial drugs. It must be taken into account that the woman is breastfeeding the baby. If the patient's condition is severe, breastfeeding should be reconsidered.

In addition to antibiotic therapy, other drugs are prescribed:

1. To improvethe contractility of the uterus is prescribed oxytocin after the introduction of "No-shpa". At the same time, the outflow of uterine secretions improves, the area of the wound surface is reduced, and the decay products are worse absorbed into the blood. Also, to improve the contractility of the genital organ, a cold heating pad can be applied to the uterus.
2. Immunocorrective drugs - "Kipferon", "Viferon", human immunoglobulin. If the patient's viral infections worsen, antiviral agents are prescribed.
3. Symptomatic therapy - painkillers.

In the chronic form of the disease, therapeutic measures are as follows:

• hearth sanitation;
• remove synechia;
• hormonal therapy aimed at stabilizing hormonal levels.

Physiotherapy helps to alleviate the course of the disease:

1. Nemeck interference current treatment - low and medium frequencies using four electrodes.
2. Pulsed low-frequency currents - prescribed for early rehabilitation.
3. Acupuncture - simulates the functionality of the immune system.

With regard to radical therapies, in severe cases prescribed:

• hysteroscopy;
• vacuum-aspiration;
• washing the cavity of the genital organ with antiseptics.

Such procedures are not carried out in the following cases:

• septic shock;
• suture failure after cesarean;
• purulent-inflammatory processes outside the reproductive organ;
• pelvioperitonitis or peritonitis.

Treatment with folk remedies

How is endometritis treated after childbirth by non-traditional means? For the treatment of an acute form of the disease, women are encouraged to douche with herbal decoctions.

For example:

• oak bark;
• marshmallow root;
• cuff.

These procedures relieve pain well. To prepare the drug, you need to take all the herbs in equal proportions, grind and mix thoroughly. A tablespoon of the collection must be poured with a glass of boiling water, put on fire and boil over low heat for 15 minutes. Then insist, strain and use as intended.

Inflammation in the uterus relieves a mixture of turpentine, marshmallow flowers and lard, which is applied to the lower abdomen.

Uterine inflammation is well treated by elm bark, a decoction of which is prepared similarly to the recipe proposed above.

Chronic endometritis after childbirth, according to patient reviews, is well treated with the following collection:

1. Birch leaves, cuff leaves, blueberries, geranium flowers, tansy, violet, chamomile, oak bark.
2. Snake mountaineer root, calendula, plantain, yarrow, thyme, bird cherry fruit, agrimony.
3. Marshmallow root, wormwood, aspen buds.

Ingredients for decoctions should be taken in equal amounts, and then add a glass of boiling water to a tablespoon of the collection. Maintain decoction forlow heat for 15 minutes, then strain and use as a douche or bath.

Possible consequences

If there is no timely treatment of endometritis, metritis develops. Metroendometritis is an inflammation of the basal layer of the endometrium and the adjacent myometrium.

Such a complicated disease is divided into three stages:

1. Only endometrial islets and sheath are affected. A reactive inflammatory process is observed in the muscular layer of the uterus - the vessels expand, tissues swell, and small cell infiltration occurs.
2. In addition to the above, deeper layers are affected.
3. Infectious lesion is covered by parametrium and perimetry, pelvioperitonitis develops.

Chronic form of metroendometritis almost always leads to infertility.

With a protracted form of pathology, salpingitis and oophoritis can develop - the inflammatory process spreads to the fallopian tubes and ovaries.

In addition, the following dangerous pathologies can be complications of endometritis:

• thrombophlebitis is an inflammatory process that affects blood vessels in the pelvic region;
• pelvic abscess - an infectious purulent focus that has its own walls;
• sepsis.

Prevention measures

To reduce the risk of developing postpartum endometritis, you must adhere to the following principles:

1. Plan and prepare for pregnancy. A woman before the onsetpregnancy should identify and cure all chronic diseases of a gynecological nature.
2. Timely register at the antenatal clinic. Recommended period - up to 12 weeks.
3. Regular preventive examinations by an obstetrician-gynecologist. In the 1st trimester, this must be done once a month, in the 2nd trimester - once every 2 weeks, in the 3rd trimester - once a week.
4. Follow the rules of dietary nutrition. The diet of a pregnant woman should be moderate in carbohydrates and fats and sufficient in protein foods. It is recommended to exclude fatty, fried, sweet and starchy foods, eat more dairy products, meat and legumes.
5. Practice physical therapy for pregnant women. Minor physical activity is shown - walking, stretching, breathing exercises. You need to do about half an hour a day.

An important role in the prevention of postpartum endometritis is the correct delivery:

1. Indications and contraindications for vaginal delivery or caesarean section should be assessed.
2. Examination of the placenta for tissue defects and integrity.
3. Administration of antibacterial drugs for prolonged anhydrous labor, as well as for caesarean section.

Conclusion and conclusions

As for the prognosis of postpartum endometritis, mild and moderate forms of the disease with a competent approach to treatment end in recovery and full preservation of reproductive function. In severe decompensated form, complications are possible - septic conditions,loss of a reproductive organ and even death. That is why doctors strongly recommend expectant mothers to be attentive to their he alth both before and after childbirth. Proper preparation for pregnancy, its competent management, compliance with all the rules during delivery, as well as postpartum prevention of endometritis - these are the main precautions that will reduce the likelihood of developing endometritis and allow a woman to fully enjoy her motherhood.