Definition

Endometritis is an inflammation or irritation of the inner lining of the uterus (endometrium), although it can affect the entire uterine lining. Normally, the uterus is free of microorganisms. However, microbes can enter the uterus from the cervix and vagina, causing infection and inflammation.

Endometritis usually occurs when the amniotic sac ruptures during childbirth, making it one of the most common postpartum infections. It is important to note that endometritis differs from endometriosis, a condition in which endometrial cells grow outside the uterus.

If you want to know more about endometriosis, you can read it here: Endometriosis - Definition, Cause And Risk Factor.

Causes

Endometritis occurs when normal bacterial flora from the cervix and vagina enters the uterus. The uterus is typically a sterile environment until certain conditions, such as the rupture of the amniotic sac during childbirth, allow bacteria to enter. Bacteria are more likely to infect uterine tissue that is bleeding, weak, or injured, such as after a cesarean section.

Most postpartum endometritis cases are caused by a combination of various microbes, including aerobic (oxygen-requiring) and anaerobic (oxygen-independent) bacteria. Approximately 60% to 70% of infections are caused by bacteria such as:

• Peptostreptococcus
• Peptococcus
• Bacteroides
• Prevotella
• Clostridium
• Group A and B streptococci
• Enterococcus
• Staphylococcus
• Klebsiella pneumoniae
• Proteus sp.
• Escherichia coli

Uterine tissue injured during a cesarean section is more susceptible to infection by Streptococcus pyogenes and Staphylococcus aureus. Endometritis occurring about 7 days or more after childbirth is often caused by Chlamydia.

Risk Factor

The risk of endometritis increases under the following conditions:

• After miscarriage, prolonged labor, or childbirth
• Postpartum endometritis is 25 times more common in mothers who have had a cesarean section
• After procedures involving the pelvic organs via the cervix, such as:
• Dilation and curettage (D&C)
• Endometrial biopsy
• Hysteroscopy
• Intrauterine device (IUD) insertion
• Infection of the amniotic sac during pregnancy (chorioamnionitis)
• Low socioeconomic status
• Ruptured amniotic sac, allowing normal vaginal and cervical flora to enter the uterus
• Young maternal age at pregnancy
• First pregnancy
• Obesity
• Amniotic fluid mixed with the baby's first stool (meconium)
• Lower genital infections

The amniotic membranes and sac can also become infected during pregnancy. You can read the article here: Chorioamnionitis - Definition, Cause And Risk Factor.

Symptoms

Symptoms and complaints that patients may experience include:

• Fever, primarily the first sign of infection
• Abdominal swelling
• Abnormal vaginal bleeding
• Abnormal (greenish) and foul-smelling vaginal discharge
• Discomfort in the abdomen, including constipation
• Malaise or feeling unhealthy
• Lower abdominal, pelvic, or buttock pain
• Diarrhea (in some infections)

Diagnosis

If you have symptoms of endometritis, the doctor will first ask about your complaints and their duration. The doctor will then ask about your medical history, including your pregnancy history and past illnesses.

Next, the doctor will perform a physical examination, including vital signs (blood pressure, respiration rate, pulse, and pain level) and a pelvic exam. The uterus and cervix may be tender, and decreased bowel sounds may be noted during the abdominal examination with a stethoscope. The doctor will look for signs of infection and abnormal genital discharge.

Supporting examinations can help confirm the diagnosis. The doctor may recommend:

• Complete blood count:
• To check for increased white blood cells (common in infections)
• Blood sedimentation rate to detect inflammation
• Cultures test by taking samples from the cervix to identify the bacteria causing the infection and determine the appropriate antibiotic
• Blood cultures: If there is suspicion that the infection has spread into the blood
• Ultrasound (USG): To rule out other conditions causing postpartum complaints

Management

Since endometritis is primarily caused by bacteria, the doctor will prescribe antibiotics to treat the infection and prevent complications. To avoid bacterial resistance, follow the doctor's instructions for antibiotic use and attend follow-up appointments as scheduled.

Depending on the severity of the infection, antibiotics can be administered orally or via IV. Inform the doctor if you are breastfeeding, as some antibiotics should not be given to breastfeeding mothers.

For mild infections, the doctor may prescribe doxycycline or levofloxacin with metronidazole or amoxicillin-clavulanate. For moderate to severe endometritis, hospitalization and IV antibiotics like gentamicin and clindamycin are typically given. Alternative antibiotics may be used if you have resistance to certain antibiotics.

The doctor will monitor your condition for improvement within 24-72 hours. If endometritis is caused by bacteria that also cause sexually transmitted infections (STIs), inform the doctor so your partner can also be treated.

You can read articles about sexually transmitted infections here: Sexually Transmitted Infections - Definition, Cause And Risk Factors.

Complications

Most cases of endometritis resolve with proper antibiotic treatment. Untreated endometritis can lead to severe infection and more serious complications, including:

• Infertility
• Pelvic peritonitis (infection spreading to the pelvic cavity layer)
• Abscess formation in the pelvis or uterus
• Hematoma (blood accumulation outside the blood vessels)
• Systemic infection (bacteremia)
• Septic shock, or a condition where organs do not receive enough oxygen due to the body's excessive response to infection

These complications can cause tissue death in the uterus, requiring a hysterectomy to treat the infection. Untreated endometritis can also lead to fatal outcomes, including death.

Prevention

Endometritis can occur after childbirth. Clean labor and delivery rooms or operating rooms can reduce the risk of infection. STIs can also cause endometritis, so both partners should be treated to prevent it. Practice safe sex, such as using condoms and not having multiple sexual partners.

Women undergoing a cesarean section are given antibiotics before the procedure to prevent infection.

When to See a Doctor?

See a doctor if you experience symptoms like fever, severe abdominal swelling, or pain. A consultation can help determine whether your symptoms are concerning and whether further examination is needed.

Looking for more information about other diseases? Click here!