Content Reviewers:Rishi Desai, MD, MPH
Contributors:Sam Gillespie, BSc
The female reproductive system is divided into upper and lower genital tracts.
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.
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.
To make matters worse, under certain conditions, bacteria can have even more time to reach the endometrium.
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.
These tissues provide a good environment for bacteria to grow and cause an infection in the uterus.
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.
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.
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