Endometritis

Endometritis is inflammation of the endometrial lining, inside the uterus, but may extend to other structures in the uterus. Endometritis should not be confused with endometriosis.

There are two distinct forms of endometritis: pregnancy-related and non-pregnancy-related. When endometritis is not pregnancy related, it is known as pelvic inflammatory disease.

Endometritis may be linked with inflammation of the fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (pelvic peritonitis). Pelvic inflammatory disease is any combination of these ‘itis’s’, which may be accompanied by a fever and lower abdominal pain.

Endometritis is either chronic or acute. In acute endometritis, neutrophils can be found within the endometrial glands, whereas chronic endometritis has plasma cells and lymphocytes in the endometrial stroma.

Invasive gynaecological procedures and pelvic inflammatory disease are the most common precursors to acute endometritis, and in those giving birth, postpartum infection is the most common cause.

Chronic endometritis in those giving birth is usually caused by remnants of delivery remaining. In those without a pregnancy, chronic endometritis is typically linked with an infection and possibly with older versions of an intrauterine device (IUD).

Symptoms of endometritis

• Fever
• Lower abdominal pain
• Foul smelling labour discharge (lochia)
• Abnormal vaginal bleeding
• Abnormal vaginal discharge
• Painful sex (dyspareunia)
• Painful urination (dysuria)
• Feeling tired and a bit unwell
• Tender uterus

Bacteria most commonly associated with endometritis

• Ureaplasma urealyticum
• Peptostreptococcus
• Gardnerella vaginalis
• Bacteroides bivius
• Group B Streptococcus
• Chlamydia – associated with late-onset postpartum endometritis, and may be asymptomatic
• Enterococcus – sometimes found in women who have had cephalosporin prophylaxis

Endometritis usually has two or three organisms that contribute to it, typically from vaginal flora. Herpes and tuberculosis are rare causes.

Who gets endometritis?

Any woman can get endometritis, but it’s more common in women who have babies. Those having cesarean deliveries are more at risk than those with vaginal births. Long labours, manual placental removal and older women get more endometritis.

If the normal cervical plug is missing (for example due to an infection like bacterial vaginosis), the risk is increased. Women who douche and those who have unprotected sex with multiple partners are at a greater risk.

Treatment for endometritis

Treatment is using antibiotics, and almost 90 per cent of the time, they work within 72 hours. Endometritis can be a cause of a labouring mother’s death due to sepsis, but it’s uncommon now. It is not associated with further negative outcomes if treated in a timely fashion.

What else could it be?

It could be appendicitis or pelvic inflammatory disease, and in children, it could be a urinary tract infection.