Endometritis

Definitions & Key takeaways

Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. It is usually caused by normal flora of the genital tract if the endometrium is breached, but can also be caused by sexually transmitted infections, such as Chlamydia trachomatis and Neisseria gonorrhoeae infections.

Common symptoms are fever, pain in the pelvis or lower abdomen, abnormal vaginal discharge, and painful sexual intercourse. Procedures which can lacerate the endometrium such as childbirth, abortion, surgery on the uterus or other pelvic organs, and insertion of an intrauterine contraceptive device (IUD), all increase a chance of having endometritis.

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Introduction0:00–0:40

Endometritis is an inflammation of the endometrium, which is the inner lining of the uterus. It is usually caused by an infection of the endometrium from bacteria that normally live in the female lower genital tract, but it could also be caused by bacteria from outside the body.
The female reproductive system is divided into upper and lower genital tracts. The upper genital tract consists of the uterus, ovaries, and fallopian tubes.
The lower genital tract in turn consists of the cervix, vagina and the external genitals, which includes the labia and the clitoris.

Physiology0:40–1:36

Now, The uterus consists of 3 layers, an outer thin layer called the perimetrium or the serosa, a middle smooth muscle layer called the myometrium, and the innermost layer, the endometrium.
The endometrium has two layers, an inner functional layer made up mainly of glands and supporting connective tissue, called stroma, and an outer thin basal layer which regenerates the overlying functional layer after each menstrual cycle.
Alright, normally, there are many species of bacteria living in the female’s lower genital tract, and this is called the normal flora.
These include Ureaplasma urealyticum, Peptostreptococcus and group B Streptococcus. Under normal conditions, these bacteria live there happily without causing any harm, however, if they reach the upper genital tract, they can cause an infection like endometritis if they make it to the uterus.

Pathology1:36–4:19

Endometritis is a common problem during pregnancy because bacteria can easily reach the uterus during childbirth. Okay, so normally the fetus is surrounded by membranes and amniotic fluid, and the uterus’s opening is sealed by a mucous plug.
This mucus plug has antimicrobial properties, preventing bacteria from reaching the uterus. Typically, during vaginal delivery, the mucus plug is shed, the cervix widens, and the membranes around the fetus rupture, so the baby can be delivered.
However, bacteria in the lower genital tract can take advantage of this, and sneak through the opening up to the uterus, causing endometritis.
To make matters worse, under certain conditions, bacteria can have even more time to reach the endometrium. This can occur when there’s prolonged labor, and premature rupture of membranes, where the membranes around the fetus have ruptured before the onset of labor.
In addition, if the amniotic fluid or the membranes around the fetus become infected, a condition known as chorioamnionitis, the infection can spread to the nearby endometrium causing it to be infected as well.
In addition, people who give birth by cesarean section are even more likely to have endometritis after childbirth. This is because cesarean section makes it easier for the bacteria in the lower genital tract to reach the endometrium, and even bacteria from outside the body can make their way in.
Endometritis can also occur when placental or fetal tissues are not completely removed from the uterus after delivery or abortion.
These tissues provide a good environment for bacteria to grow and cause an infection in the uterus. Now, apart from childbirth, there are other factors that makes it easier for bacteria from the lower genital tract to reach the endometrium, even in non-pregnant females.
This can occur during hysteroscopy, where the inside of the uterus is viewed using a camera inserted through the vagina, and when there’s an intrauterine contraceptive device, which has a thread that reaches down to the cervix or the vagina.
When these devices are inserted into the uterus, they might introduce forign bacteria accidentally. Finally, endometritis can be caused by outside bacteria such as Chlamydia trachomatis or Neisseria gonorrhoeae, which are sexually transmitted infections.
Also, some cases of endometritis can occur in a female with tuberculosis, in which Mycobacterium tuberculosis spreads from the lungs into the blood and travels to other organs such as the uterus.

Symptoms4:19–5:00

Alright, endometritis can be acute or chronic,. People with acute endometritis, can present with fever, abnormal uterine bleeding, lower abdominal pain, dysuria, which is painful urination, or dyspareunia, which means pain during sexual intercourse.
When endometritis occurs after childbirth, the lochia, which is the normal vaginal discharge after giving birth, can become purulent, meaning yellowish, and foul smelling.
In chronic endometritis, people often have no symptoms with normal physical examination, however, some may experience similar symptoms to those of acute endometritis, although milder Now, endometritis has a number of complications, including the spread of the bacterial infection from the endometrium to the underlying myometrium, where it’s called endomyometritis, or to the peritoneum causing peritonitis.

Complications5:00–6:14

The infection can also spread to the fallopian tubes, causing salpingitis, or to the ovaries, causing oophoritis. One potential complication of chronic endometritis, especially when it’s caused by tuberculosis, is Asherman syndrome, also known as intrauterine adhesions.
Asherman syndrome occurs when the inflammation of the endometrium is so severe that it makes the basal layer unable to regenerate the functional layer.
Instead, the basal layer undergoes fibrosis, where normal tissue is replaced by collagen. This leads to the formation of multiple fibrous bands, also called adhesions or synechia , which make the uterine walls stick to each other.
This whole process causes the endometrium to fail to respond to hormonal stimulation, leading to the absence of menstrual bleeding.
In severe cases, these fibrous bands can completely obliterate the uterus, causing infertility or recurrent pregnancy loss.

Diagnosis6:14–6:59

Diagnosis of endometritis is usually based on clinical findings. However, an endometrial biopsy can help make the diagnosis, although it’s not routinely done.
Under the microscope the normal endometrium sometimes has lymphocytes in the endometrial stroma. In acute endometritis, the endometrium is infiltrated by neutrophils, which are the hallmark cells of acute inflammation.
In chronic endometritis, the presence of more lymphocytes, especially plasma cells, in the stroma is diagnostic. When endometritis is caused by tuberculosis, an additional finding is the presence of granulomas in the endometrium, which is why it’s also called chronic granulomatous endometritis.

Treatment6:59–7:48

Treatment of endometritis involves the use of antibiotics. For endometritis that occurs after childbirth, a combination of clindamycin and gentamicin is used.
If endometritis is caused by remaining placental or fetal tissues, a procedure called dilatation and curettage, or D&C, is done, where the cervix is dilated, and the remaining tissues are removed by a curette.
For endometritis caused by Chlamydia trachomatis or Neisseria gonorrhoeae, a combination of doxycycline and ceftriaxone is used to treat the infection.
Finally, if endometritis is caused by tuberculosis, the treatment will include the use of anti-tuberculosis drugs such as isoniazid, rifampin, pyrazinamide, and ethambutol.

Review7:48–8:36

All right as a quick recap … Endometritis refers to the inflammation of the endometrium. Endometritis is usually caused when normal flora in the lower genital tract reach the endometrium.
This can happen during childbirth, gynecologic procedures, and due to the presence of intrauterine contraceptive device.
Other cases of endometritis are due to sexually transmitted infections, typically due to Chlamydia trachomatis and Neisseria gonorrhoeae.
Endometritis can be acute or chronic. People with acute endometritis are more likely to have symptoms, whereas many of those with chronic endometritis are asymptomatic.
On histology, acute endometritis has neutrophils in the endometrium, while in chronic endometritis, the presence of plasma cells in the endometrium is diagnostic.