The inner layer of the genital organ is covered with endometrium. Endometritis is the inflammatory process of this layer. A large number of women face this pathology. It can be provoked by intrauterine diagnostic tests, abortions, but most often endometritis is diagnosed after childbirth.
The function of the endometrium is the creation of certain conditions for the attachment of a fetal egg to the uterus. Through the vessels of the endometrium, the unborn baby receives oxygen. Therefore, it is very important that this layer after childbirth recovers without consequences.
What is endometritis?
Endometritis after childbirth adversely affects subsequent pregnancies, because for the normal bearing of a child it is very important that the mucous membrane is full.
During the menstrual cycle, the endometrium changes, resulting in optimal conditions for pregnancy. If pregnancy does not occur, the endometrial layer is rejected (excreted with menstruation), leaving only the germ layer. After the end of menstruation, the cells of the germ layer begin to divide, and the endometrium is again ready to accept a fertilized egg.
If after childbirth the genital organ becomes inflamed, then all the processes that occur in it are violated. A woman may develop various complications with the following attempts at conception.
If we look at the statistics, endometritis occurs in 2-4% of women in labor, and after cesarean section, the risk of developing pathology is even higher - 10-20%.
Etiology of the phenomenon
After birth, the intrauterine cavity is an open bleeding wound. Epithelial cells restore the inner layer of the genital organ after about a month and a half. Until this time, the risk of infection is very high. The causative agents of the inflammatory process are constantly present in the body of a woman, but begin to multiply actively only under certain conditions. Childbirth - these are just the conditions under which the pathogenic flora becomes active.
The causes of endometritis after childbirth are various, but most often doctors distinguish the following:
- Decreased immunity of women. The last weeks of pregnancy and some time after birth, the woman’s immunity is not in the best condition, therefore, it is difficult for the body to fight the infection on its own. Restoring the previous level of immunity takes several days - from 5 to 10, depending on the method of delivery.
- Surgical intervention in the genital organ. In addition to the fact that immunity is reduced, the surgical incision is exposed to primary infection. After surgery, the uterus contracts worse, which means self-cleaning is almost impossible, which increases the risk of developing uterine endometritis after childbirth.
Also, the development of pathology is facilitated by:
- Chronic foci of infection in the body.
- Inflammatory processes of internal organs.
- Endocrine ailments and metabolic disorders.
- Endometrial injuries that were triggered by prolonged use of intrauterine contraceptives, miscarriages, abortions, or diagnostic curettage prior to pregnancy.
- Complications during the bearing of the baby. Polyhydramnios, the threat of miscarriage, exacerbation of chronic diseases, isthmic-cervical insufficiency, acute infections, placenta previa - all this can give impetus to the development of endometritis after childbirth. In addition, invasive diagnostics, as well as hemming of the cervix, can also provoke this ailment.
- Complications during childbirth. Prolonged labor, a long anhydrous period, heavy blood loss, manual separation of the placenta and placenta , and so on.
- The birth of a baby infected in utero.
- Difficulties in the postpartum period. The causes of endometritis after childbirth can be found in violation of the rules of postpartum hygiene, too long bed rest, poor involution of the genital organ.
It must be said that each individual factor cannot lead to endometritis, however, in their totality, the probability of developing the disease increases.
Signs of postpartum endometritis
In the female body, endometritis after childbirth can occur in acute or chronic form. The clinical picture varies depending on the form of the disease. Acute endometritis after childbirth is accompanied by vivid signs, which allows you to diagnose and treat the pathological process in time. In the chronic form, the symptoms are blurry and mild. Often, women do not attach importance to such symptoms, attributing it to the postpartum period, thereby delaying the visit to the gynecologist. Such neglect can lead to irreversible consequences.
In addition, signs of endometritis after childbirth directly depend on the severity of the disease.
In a mild course, symptoms begin to appear in the first week after delivery.
In this case, endometritis after childbirth, the symptoms will have the following:
- increase in body temperature;
- tachycardia;
- an increase in the size of the uterus, pain at the location of the lymph nodes;
- prolonged spotting;
- sometimes secretions accumulate in the cavity of the genital organ.
A severe form of the disease clinically begins to appear in the first 2-3 days after birth. Most often, a severe course of the disease is observed after a complex birth or operation.
In this case, endometritis after childbirth, the symptoms will have the following:
- purulent-resorptive fever;
- pain in the uterus;
- pus in the suckers;
- discharge passes from the uterus to the pyometer;
- anemia.
In addition, the symptoms of endometritis in women after childbirth are manifested in a worsening of the general condition:
- weakness;
- headache;
- loss of appetite;
- insomnia;
- pain in the lower abdomen.
Endometritis after cesarean section
Symptoms and treatment of endometritis after childbirth depend on the method of delivery. Operational extraction of the baby is accompanied by circumstances that do not happen during natural birth:
- To remove the baby, the uterine wall is cut, which greatly facilitates the path to the uterine mucosa to infectious agents. In addition, if suture infection occurs, the infection can spread to other layers of the genital organ, so the course of endometritis after cesarean is quite severe.
- Suture material that is used by doctors, a woman’s body can be rejected, and the presence of a suture worsens uterine contractions, which leads to the fact that lochia is retained in the cavity and become a breeding ground for bacteria.
- After cesarean, a woman has glucocorticosteroid insufficiency, which significantly reduces immune defense. Also, histamine is synthesized in large quantities in a woman, causing an intracellular conflict, which also worsens the body's ability to resist infection.
With any method of delivery, a woman has a risk of developing endometritis, but after cesarean it is highest:
- The body becomes more vulnerable due to a decrease in the activity of protective forces.
- The woman has pathologies that forced doctors to have a cesarean section - diabetes, kidney problems, metabolic disorders, and so on.
- In the process of giving birth to a woman, a woman lost a lot of blood.
- Polyhydramnios.
- Neglect by medical workers of the rules of septic and antiseptic during surgery and in the postoperative period.
Acute endometritis
As already mentioned, the symptoms and treatment of endometritis in women after childbirth depend on the form of pathology.
In acute endometritis, a woman complains of the following symptoms:
- very high temperature - up to 39 degrees;
- pain in the lower abdomen, which may be given to the sacral region;
- blood-purulent, serous or serous-purulent discharge;
- general weakness and weakness.
It is very important to pay attention to the selection. Normally, after birth, bloody discharge can be observed for a couple of days, then their amount gradually decreases, they become brown or yellowish. By about the eighth week, all discharges completely stop. Acute endometritis is accompanied by abundant secretions, and in the presence of pus they can turn green.
Chronic endometritis
Chronic endometritis after childbirth is accompanied by:
- falling temperature;
- periodic uterine bleeding;
- secretions with a putrid odor;
- pain during the act of defecation.
Diagnostic measures
Treatment of endometritis after childbirth should begin after a thorough diagnosis:
- Interviewing the patient about symptoms and complaints, as well as collecting information about past infectious diseases.
- General examination - measurement of pulse, temperature and blood pressure, as well as palpation of the uterus.
- Examination of the cervix in the gynecological chair.
- Palpation of the uterus to determine its size and degree of pain.
- Ultrasound of the uterus - provides information about the presence in the genital organ of placental tissue and blood clots, and also indicates its exact size.
- Laboratory tests - blood, smear, bacterial culture.
Treatment principles
Postpartum endometritis can be treated conservatively or surgically.
If at the time of the onset of the disease the woman has not yet been discharged from the hospital, she will be transferred to a special department, where women are observed who have certain postpartum complications. If a woman has found signs of endometritis already at home, she should be hospitalized in the gynecology department.
The main conservative treatment of pathology is the use of antibacterial drugs. In this case, it is necessarily taken into account that a woman is breastfeeding a baby. If the patient's condition is serious, the issue of breastfeeding is reviewed.
In addition to antibiotic therapy, other drugs are prescribed:
- To improve the contractility of the uterus, oxytocin is prescribed after the introduction of No-shpa. At the same time, the outflow of uterine secretions improves, the area of the wound surface decreases, and the decay products are worse absorbed into the blood. Also, to improve the contractility of the genital organ, a cold heating pad can be assigned to the uterus.
- Immunocorrective drugs - "Kipferon", "Viferon", human immunoglobulin. If the patient exacerbates viral infections, antiviral agents are prescribed.
- Symptomatic therapy - painkillers.
In the chronic form of the disease, therapeutic measures are as follows:
- sanitation of the focus;
- removal of synechia;
- hormone therapy aimed at stabilizing the hormonal background.
Physiotherapeutic procedures help to ease the course of the disease:
- Nemek interference current treatment - the use of low and medium frequencies through four electrodes.
- Pulse low-frequency currents - are prescribed for early rehabilitation.
- Acupuncture - simulates the functionality of the immune system.
As for radical methods of therapy, in severe cases, prescribe:
- hysteroscopy;
- vacuum aspiration;
- washing the cavity of the genital organ with antiseptics.
Such procedures are not carried out in the following cases:
- septic shock;
- suture failure after cesarean;
- purulent-inflammatory processes outside the genital organ;
- pelvioperitonitis or peritonitis.
Treatment with folk remedies
How is endometritis treated after birth with unconventional means? For the treatment of the acute form of the disease, women are invited to douch with decoctions of medicinal herbs.
For instance:
- Oak bark;
- marshmallow root;
- cuff.
These procedures relieve pain. To prepare the medicine, it is necessary to take all the herbs in equal proportions, grind and mix thoroughly. A tablespoon of the collection must be poured with a glass of boiling water, put on fire and boil over low heat for 15 minutes. Then insist, strain and use as directed.
Inflammation in the uterus removes well a mixture of turpentine, flowers of marshmallow and lard, which is applied to the lower abdomen.
Uterine inflammation treats elm bark well, a decoction of which is prepared similarly to the recipe proposed above.
Chronic endometritis after childbirth according to patients' reviews is well treated with the following collection:
- Birch leaves, cuff leaves, blueberries, geranium flowers, tansy, violet, chamomile, oak bark.
- The root of the snake mountaineer, calendula, plantain, yarrow, thyme, cherry fruits, repeshka.
- Marshmallow root, wormwood, aspen buds.
The ingredients for the decoctions need to be taken in equal quantities, and then add a glass of boiling water to a tablespoon of the collection. Soak the broth on low heat for 15 minutes, then filter and use in the form of douching or baths.
Possible consequences
If timely treatment of endometritis is absent, metritis develops. Metroendometritis is an inflammation of the basal layer of the endometrium and the adjacent myometrium.
Such a complicated disease is divided into three stages:
- Only the endometrial islets and the decaying membrane are affected. In the muscle layer of the uterus, a reactive inflammatory process is observed - the vessels expand, the tissues swell, small-cell infiltration occurs.
- In addition to the above, deeper layers are affected.
- Infectious lesions are covered by parametrium and perimetry, pelvioperitonitis develops.
The chronic form of metroendometritis almost always leads to infertility.
With a protracted form of pathology, salpingitis and oophoritis can develop - the inflammatory process spreads to the fallopian tubes and ovaries.
In addition, the following dangerous pathologies can be complications of endometritis:
- thrombophlebitis - an inflammatory process that affects blood vessels in the pelvic area;
- pelvic abscess - an infectious purulent lesion that has its own walls;
- sepsis.
Preventive actions
To reduce the risks of developing postpartum endometritis, you must adhere to the following principles:
- Plan pregnancy and prepare for it. Even before pregnancy, a woman should identify and cure all chronic gynecological diseases.
- Timely register with the antenatal clinic. The recommended period is up to 12 weeks.
- Regular preventive examinations of an obstetrician-gynecologist. In the 1st trimester, this must be done once a month, in the 2nd trimester - once every 2 weeks, in the 3rd trimester - once a week.
- Follow dietary guidelines. The diet of a pregnant woman should have a moderate content of carbohydrates and fats and a sufficient content of protein food. It is recommended to exclude fatty, fried, sweet and flour, to consume more dairy products, meat and legumes.
- Exercise for pregnant women. Minor physical activity is shown - walking, stretching, breathing exercises. You need to do about half an hour a day.
Of no small importance in the prevention of postpartum endometritis is the correct delivery:
- It is necessary to evaluate the indications and contraindications for natural childbirth or for cesarean section.
- Inspection of the placenta for tissue defects and integrity.
- The introduction of antibacterial drugs for prolonged anhydrous course of childbirth, as well as for cesarean section.
Conclusion and Conclusions
As for the forecasts of postpartum endometritis, mild and moderate forms of the disease with a competent approach to treatment end in recovery and complete preservation of reproductive function. In severe decompensated form, complications are possible - septic conditions, loss of the genital organ, and even death. That is why doctors strongly recommend expectant mothers to be attentive to their health both before and after childbirth. Proper preparation for pregnancy, its proper management, compliance with all the rules during delivery, as well as postpartum prophylaxis of endometritis are the main precautions that will reduce the likelihood of developing endometritis and allow the woman to fully enjoy her motherhood.