Endometritis

• Causes, incidence, and risk factors

  Endometritis is caused by infections such as chlamydia, gonorrhea, tuberculosis, or mixtures of normal vaginal bacteria. Endometritis is more likely to occur after miscarriage or childbirth, especially after a long labor or c-section.

  A medical procedure that involves entering the uterus through the cervix will increase the risk of developing endometritis. This includes a D and C, hysteroscopy, and placement of an intrauterine device (IUD).

  Endometritis can occur at the same time as other pelvic infections such as acute salpingitis, acute cervicitis, and many sexually transmitted diseases (STDs).

• Symptoms
  • Abdominal distention or swelling
  • Abnormal vaginal bleeding
  • Abnormal vaginal discharge
  • Discomfort with bowel movement (constipation may occur)
  • Fever (100 to 104 degrees Fahrenheit)
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Lower abdominal or pelvic pain (uterine pain)
• Signs and tests

  The health care provider will perform a physical exam and a pelvic exam. The lower abdomen may be tender. Bowel sounds may be decreased. A pelvic exam may show the uterus and cervix is tender. There may be cervical discharge.

  The following tests may be performed:

  • Cultures from the cervix for chlamydia, gonorrhea, and other organisms
  • Endometrial biopsy
  • ESR (sedimentation rate)
  • Laparoscopy
  • WBC (white blood count)
  • Wet prep (microscopic exam of any discharge)
• Treatment

  Antibiotics are used to treat and prevent complications of endometritis. If you've been prescribed antibiotics following a gynecological procedure, it is very important to finish all the medication and follow up with your health care provider.

  You may need to be admitted to a hospital if you have a complicated case of endometritis, such as those that involve serious symptoms, or which occur after childbirth.

  Other treatments may involve:

  • Fluids through a vein (by IV)
  • Rest

  Sexual partners may also need to be treated if the condition is caused by a sexually transmitted disease.

• Expectations (prognosis)

  Most cases of endometritis go away with antibiotics. Untreated endometritis can lead to more serious infection and complications with pelvic organs, reproduction, and general health.

• Complications
  • Infertility
  • Pelvic peritonitis (generalized pelvic infection)
  • Pelvic or uterine abscess formation
  • Septicemia
  • Septic shock
• Calling your health care provider

  Call for an appointment with your health care provider if you have symptoms of endometritis.

  Call immediately if you have symptoms and have recently had a baby, miscarriage, abortion, IUD placement, or any surgery involving the uterus.

• Prevention

  Endometritis caused by sexually transmitted infections can be prevented by:

  • Early diagnosis and complete treatment of sexually transmitted diseases in yourself and all sexual partners
  • Practicing safe sex, such as using condoms

  The risk of endometritis is reduced by the careful, sterile techniques used by appropriate providers when delivering a baby or perfoming an abortion, IUD placement, or other gynecological procedures.

• References

  Duff P. Maternal and perinatal infection -- bacterial. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2007:chap 49.

  Eckert LO, Lentz GM. Infections of the upper genital tract. In: Katz Vl, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap 23.

  Faro S. Postpartum endometritis. Clin Perinatol. 2005;32(3):803-814.

Review Date: 11/1/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.