Metroendometrit

Metroendometrit is inflammation of mucous (endometritis) and muscle (myometrium) membranes of the uterus. Disease is the result of penetration into the uterus septic infection (strepto-and staphylococci, gonokokkov, coliforms) and certain other microorganisms hematogenous, lymphogenous or ascending path.
Over and symptoms. Most often metroendometrit occurs on the 3-4th day after delivery or abortion. Development of the infection is facilitated by the presence in the uterus blood clots or remnants of placental tissue. The disease begins with fever to 38-38,5 degrees and chills. Pulse Ochsen, corresponds to the temperature. Patients complain of weakness, abdominal pain, headache, loss of appetite. At a palpation of the uterus through the anterior abdominal wall appears to have slowed its reverse development (subinwalucia). Uterus in acute metroendometrit soft, swollen and painful to palpation in the lateral parts. The discharge becomes murky and often become putrid smell. Sometimes inflammatory process applies to all layers of the uterus (metritis), appendages and peritoneum (see Pelvioperitonit). When using antibiotics clinical picture of acute metroendometritis may have destroyed the nature.
Chronic metroendometrit is mainly characterized by a purulent fluid secretions and menstrual function in the form of cyclic bleeding - menorragii (see the Menstrual cycle). The uterus is enlarged, firm, painless.
Symptoms of gonorrheal metroendometritis (acute and chronic) combined with other common symptoms of this infection (see Gonorrhea).
When metroendometrit tubercular etiology mainly affected the mucous membrane tubes and uterus (endometritis). The main symptom of TB endometritis is infertility and menstrual cycle disorder (bleeding, amenorea). Decisive in the diagnosis of tuberculous endometritis are these histological examination of a scraping of the endometrium.
Treatment. Patients with metroendometrit be hospitalized. In the acute stage of the disease prescribe bed rest, cold on the bottom of the stomach, antibiotics, pain relievers. When bleeding - drugs LPV, Katarina chloride (staticin), pituitrin, chloride calcium, ascorbic acid, menadione. In chronic metroendometrit shows the different kinds of physiotherapy (diathermy, mud treatment, paraffin, ozokerite, etc.). In cases of tuberculous endometritis designate specific therapy (streptomycin, PASK, ftivazide and others).

Metroendometrit (metroendometritis; from the Greek. metra - uterus and endon - inside - is an inflammation of the womb. If inflammation is localized only within the mucosa of the uterine body, it is called "endometritis". The term " metritis," or "the myometrium", indicate inflammation of the muscular layer of the uterus. Typically, metritis precedes endometritis.
Etiology. The reason for metroendometritis more often is infection. Pathogens - Streptococcus, Staphylococcus, Streptococcus, E. coli, some anaerobic bacilli tuberculosis and diphtheria, pale Treponema, radiant fungus and other Metroendometrit can be observed in the number of acute infectious diseases (flu, sore throat, scarlet fever, measles, the fever and others). The development of infection in the uterus promote long and frequent blood circulation disorders, such as long-existing congestion in small pelvis arising from the misuse of the provisions of the uterus, tumors of the small pelvis, Masturbation, unfinished intercourse, etc.
Most often metroendometrit develops with the spread of infection in the uterus during abortion, childbirth and menstruation, and diagnostic and therapeutic procedures, if violated rules of aseptics and antiseptics. The inflammatory process can move on to the uterus and fallopian tubes (with the defeat of their TB), with the vermiform process and intestines. There are cases of inflammation of the uterus metastatic nature (sore throat, influenza and other acute infectious diseases).
Causes of metroendometritis can be parasitic infestations, as well as bruises, wounds, the impact of thermal and chemical factors (poisoning phosphorus, arsenic, carbon disulphide).

acute endometritis
Fig. 1. Acute endometritis: periglandular polynuclear infiltration.
chronic endometritis
Fig. 2. Fibroblastic the transformation of endometrial stroma in the form of chronic endometritis (large increase).

Pathological anatomy. Inflammatory processes in the uterus often begin with a mucous membrane. In acute inflammation of the mucous membrane of the uterus thickens, there are sharp hyperplasia, tissue swelling and polynuclear infiltration (Fig. 1). Due to edema endometrial stroma becomes non-fibrous, when pronounced redness may occur extravasate. Cancer of the endometrium is compressed due to swelling and infiltration stroma. Purulent fusion of tissues occurs rarely. In the subsequent polynuclear to infiltrate join lymphocytes, still later appear plasma cells.
In chronic metroendometrit in the stroma of the uterus was observed fibroblastic the transformation connecting megjeleniti tissue (Fig. 2)on the surface of the mucous membrane of the uterus appear uneven and small polypous education.
In some cases there ingrowth glands in the underlying muscle membrane - internal endometriosis occurs in the uterus. Hard place
forms of chronic endometritis can be observed violations of cyclic changes in the mucous membrane of the uterus, despite normal ovarian function.
When puerperal endometritis the inflammatory process captures the falling shell and the adjacent layer of the muscular wall of the uterus. The superficial layers of the falling shell nekrotizirutee, in the layer below is organized inflammatory infiltrate from polinucleares and lymphocytes. In the muscle of the uterus are observed swelling, expansion and thrombosis blood vessels (see Microthrombosis). The greatest danger of further spread of infection is an inflammatory process of the uterus in the field of placental site.
As a result of severe postpartum metroendometritis sometimes there is atrophy of the endometrium.
After the formation of granulation tissue can develop cicatricial changes in mucous and muscular layers of the uterus.
Over and symptoms. Acute metroendometrit accompanied by General reaction: fever, malaise, poor health, pain in the abdomen, often radiating to the rump. Palpation of the uterus is soft, swollen, enlarged, painful; from the cervical canal expire purulent discharge. Chronic metroendometrit is mainly characterized by a purulent fluid secretions and menstrual function. The uterus is often enlarged, firm, painless. Menstrual cycle disorder is more likely to occur in the form of cyclic bleeding - menorragii.
Postpartum metroendometrit is usually found on the 3-4th day after birth: temperature increases (38,5-39,5 degrees), there is chilling, sometimes vomiting, quickens the pulse. Patients complaining of General weakness, headache, bad appetite and sleep. In the survey find the uterus subinvolution, sensitivity to palpation; when feeling often noted pain in the lateral parts of the uterus. Lochia (see the Postpartum period) is not bleeding or bloody-serous and murky, sometimes with rotting smell, they become bloody-purulent or purulent. When the delay outflow separated from the uterus may be lohiometra with increasing temperature, the strength of the effects of intoxication and the emergence of a cramping pain. Postpartum M lasts 8-10 days. The temperature at the high numbers remission of up to 1 degree lasts 5-7 days, and in the future is subfebrile. If the process continues for more than 10 days, it usually indicates the spread of the infection outside the inner surface of the uterus.
Sometimes when metroendometrit, especially older women, in the narrowing of the cervical canal and Scarring in the uterine cavity pus accumulates, there pyometra, which is clinically manifested by high temperatures, cramping pains, and the increase of the uterus, have elastic consistence. Pyometra can occur when cancer of the uterus; with suspected cancer after mirovaniya of critical phenomena is a trial scraping (see).


Diagnosis of metroendometritis in the acute stage does not present much difficulty. It is based on the anamnesis (childbirth, miscarriage, infection gonorrhoea, intrauterine intervention and other) and on the results of a General and gynaecological examination (fever, soreness of the uterus, purulent discharge). The diagnosis of chronic stages M. harder. Gynecological examination are determined enlarged, firm, painless uterus expressed selection. Chronic inflammation of the uterus may be accompanied by gravity and pressure in the pelvic area, pain in the lower back and rump. These symptoms are not pathognomonic for M, as they are observed with other gynecological diseases.
For the diagnosis of M. use laboratory data: changes in the pattern of blood in acute processes, bacterioscopic, and bacteriological determination of the nature of the pathogen of infectious disease. It should be borne in mind that when gonococcal postpartum M gonococci are located in separated from the uterine cavity is already on the 3-4th day after birth. This is especially important because gonococcal M often occurs as a mild disease; the temperature rises by about 6-8 day of the postnatal period. In chronic M. the nature of the lesion is determined by histological examination of a scraping obtained by scraping of the uterus.
Increased modified fibrous of uterus chronic metritis can give reason to suspect the fibroids or pregnancy. Dense, not changing the consistency of the womb, no softening of her neck and other signs of pregnancy, can eliminate the latter. For uterine fibroids is more usually does not diffuse increase, and tuberous irregular shape of the uterus with a separate nodes. When metroendometrit in the inflammatory process usually involves the neck of uterus and appendages.
The prognosis for acute Meters in most cases favourable. But some patients with acute M. becomes chronic with a long course of the disease. Chronic M. affect the development of the ovum and contractility of the uterus (miscarriages, premature birth, anomalies of placental attachment, the weakness of labor activity, subinwalucia uterus in the postpartum period).
Acute puerperal M often complicated by the transition of the infection to surrounding tissues, and organs, and even sepsis. The course and the nature of M depends on virulence of microorganisms and body resistance of the patient. Through all of this, the prognosis for postpartum M always good to be with some caution.
Treatment. In acute metroendometrit - rest, bed rest, cold on the bottom of the stomach, antibiotics and sulfa drugs. Pain - candles with belladonna or pantopoda, amidopyrine. Vulva and perineum at least twice a day warm wash with disinfectant solution. Of great importance are good care, skin clarity, linen, air, regular function of the bowel and bladder, a balanced diet, rich in vitamins. You everyday observation, especially hard place M (heart, lungs, kidneys, liver).
In chronic metroendometritis shows the physiotherapy - inegalitarian with calcium chloride or potassium iodide, mud cure, inhalations, paraffin - ozokeritotherapy. Mud treatment, and sulfur pools and irrigation, it is expedient to assign to treat chronic Meters in resort conditions. When bleeding is shown hemostatic means - the ergot drugs, Katarina chloride (staticin) and others, as well as calcium chloride, ascorbic acid, menadione; with prolonged bleeding and anemia - a blood transfusion 100-150 ml. a combination of inflammatory process ovarian dysfunction use of hormonal preparations (see, Menstrual cycle disorders, Metropolia). Diagnostic and therapeutic purposes in the absence of contraindications recommend scraping (see). Scraping at the post-abortion M. and the delay in the uterus parts of the ovum is made, if the infection has not spread beyond the uterus (see Abortion). When pyometra, you must empty the uterus from pus expansion of the cervical canal.