Endometritis: Difference between revisions

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===CT scan===
===CT scan===
[[Ultrasound]] and [[CT]] findings in [[postpartum]] endometritis may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>   
[[Ultrasound]] and [[CT]] findings in '''[[postpartum]] endometritis''' may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>   
* Normal [[uterus]]
* Normal [[uterus]]
or
or

Revision as of 11:43, 4 October 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Endometritis refers to inflammation of the endometrium,[1] the inner lining of the uterus. Pathologists have traditionally classified endometritis as either acute or chronic: acute endometritis is characterized by the presence of microabscesses or neutrophils within the endometrial glands, while chronic endometritis is distinguished by variable numbers of plasma cells within the endometrial stroma. The most common cause of endometritis is infection. Symptoms include lower abdominal pain, fever and abnormal vaginal bleeding or discharge. Caesarean section, prolonged rupture of membranes and long labor with multiple vaginal examinations are important risk factors. Treatment is usually with broad-spectrum antibiotics.

The term "endomyometritis" is sometimes used to specify inflammation of the endometrium and the myometrium.[2]

Acute Endometritis

Acute Endometritis is characterized by infection. The organisms isolated are most often infection are believed to be because of compromised abortions, delivery, medical instrumentation, and retention of placental fragments. Histologically, neutrophilic infiltration of the endometrial tissue is present during acute endometritis. The clinical presentation is typically high fever and purulent vaginal discharge. Menstruation after acute endometritis is excessive and in uncomplicated cases can resolve after 2 weeks of clindamycin and gentamicin IV antibiotic treatment.

In certain populations, it has been associated with Mycoplasma genitalium.[3]

Chronic Endometritis

Chronic Endometritis is characterized by the presence of plasma cells in the stroma. Lymphocytes, eosinophils, and even lymphoid follicles may be seen, but in the absence of plasma cells, are not enough to warrant a histologic diagnosis. It may be seen in up to 10% of all endometrial biopsies performed for irregular bleeding. The most common organisms are Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Streptococcus agalactiae (Group B Streptococcus), Mycoplasma hominis, tuberculosis, and various viruses. Most of these agents are capable of causing chronic pelvic inflammatory disease (PID). Patients suffering from chronic endometritis may have an underlying cancer of the cervix or endometrium (although infectious etiology is more common). Antibiotic therapy is curative in most cases (depending on underlying etiology), with fairly rapid alleviation of symptoms after only 2 to 3 days.

Chronic granulomatous endometritis is usually caused by tuberculous. The granulomas are small, sparse, and without caseation. The granulomas take up to 2 weeks to develop and since the endometrium is shed every 4 weeks, the granulomas are poorly formed.

In human medicine, pyometra (also a veterinary condition of significance) is regarded as a form of chronic endometritis seen in elderly women causing stenosis of the cervical os and accumulation of discharges and infection. Symptom in chronic endometritis is blood stained discharge but in pyometra the patient complaints of lower abdominal pain.

Pyometra

Pyometra describes an accumulation of pus in the uterine cavity. In order for pyometra to develop, there must be both an infection and blockage of cervix. Signs and symptoms include lower abdominal pain (suprapubic), rigors, fever, and the discharge of pus on introduction of a sound into the uterus. Pyometra is treated with antibiotics, according to culture and sensitivity.

See also


Overview

Historical Perspective

[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].

The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

There have been several outbreaks of [disease name], including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

Classification

Endometritis may be classified according to histopathology into two subtypes:[4]

Pathophysiology

The exact pathogenesis of [disease name] is not fully understood.

OR

It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR


[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to [disease name] usually involves the [molecular pathway]. OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.


Histopathology

Acute Endometritis

The histopathologic findings in acute endometritis include:[4]

Chronic Endometritis

The histopathologic findings in chronic endometritis (CE) include:[4][5]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries. Histopathologically, chronic granulomatous endometritis has caseating granuloma surrounded by infiltrates of lymphocytes which include endometrial stromal plasmacytes (ESPCs).[6]

Causes

Acute endometritis is mostly caused by Chlamydia trachomatis and Neisseria gonorrhoeae[7].

The most common cause of chronic endometritis (CE) is an infection with microorganisms, including:[8][9][10]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries.[6]

The rate of infections with Chlamydia trachomatis (2%–7%) and Neisseria gonorrhea (0%–8%) in chronic endometritis (CE) are very low. [8][11][12]

The association of viral infections as causes of chronic endometritis (CE) is still unclear.[13]

Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology

The prevalence of chronic endometritis (CE) is about 10% to 11% on biopsies performed from hysterectomies of patients with gynecologic conditions.[14][12]

In a study, the prevalence of CE has been reported to be 15% in infertile women with in vitro fertilization (IVF) and 42% in women with recurrent implantation failure (RIF).[15]

The prevalence of CE has been reported to be 57.8% in women with three or more recurrent pregnancy losses (RPLs).[16]

In one study, the prevalence of CE has been reported to be 14% and 27% in patients with RIF or RPL, respectively.[17]

Risk Factors

Risk factors that have been reported to be associated with chronic endometritis (CE) include:[14][18][19][20][21][22][23][24][25][26]

Screening

There is insufficient evidence to recommend routine screening for chronic endometritis (CE). However, it has been suggested that hysteroscopy may have the potential to be a screening tool for CE.[13]

Natural History, Complications, and Prognosis

Natural History

Studies have suggested that patients with chronic endometritis (CE) may develop:[27][15][16]

Complications

Common complications of chronic endometritis (CE) include:[28][29][30][27][31]

Prognosis

A study showed that after antibiotic treatment of patients with CE and recurrent pregnancy losses (RPLs), the pre-pregnancy live birth rate increased from 7% (before treatment) to 56% (after treatment).[29]

Another study showed that after antibiotic treatment of patients with CE, the implantation rate and pregnancy rate increased from 4.9% and 7.4% (before treatment) to 18.6% and 29.3% (after treatment), respectively.[32]

Diagnosis

Diagnostic Study of Choice

The histological finding of acute endometritis includes a large number of neutrophils in the endometrial stroma.[33]

The diagnosis of chronic endometritis (CE) is made with endometrial biopsy and the histological diagnostic criterion is plasma cells in the endometrial stroma.[14][34]

History, Symptoms, and Physical Examination

Symptoms of acute endometritis may include:[35]

Chronic endometritis (CE) is mostly asymptomatic but may have vague symptoms including:[35][36][37]

Laboratory Findings

Laboratory findings in acute endometritis may include:[38]

Staining used in histological detection of chronic endometritis (CE) include:

Electrocardiogram

There are no ECG findings associated with endometritis.

X-ray

There are no x-ray findings associated with endometritis.

Echocardiography or Ultrasound

There are no echocardiography findings associated with endometritis.

Ultrasound is usually not helpful in the diagnosis of endometritis. However, an ultrasound may be helpful to rule out other disorders in postpartum patients that are nonresponsive to therapy.[41] Ultrasound and CT findings in postpartum endometritis may include:[41][42][43][44][45]

or

  • Nonspecific findings due to retained products of conception:
    • Intrauterine fluid (with or without internal echoes due to blood, gas, or retained products of pregnancy)
    • Thickened heterogeneous endometrium

CT scan

Ultrasound and CT findings in postpartum endometritis may include:[41][42][43][44][45]

or

  • Nonspecific findings due to retained products of conception:
    • Intrauterine fluid (with or without internal echoes due to blood, gas, or retained products of pregnancy)
    • Thickened heterogeneous endometrium

Compared to ultrasound, CT scan is more helpful in identifying the inflammation of the soft tissues and pelvic abscesses.[46]

MRI

There are no specific MRI findings associated with endometritis.

Other Imaging Findings

Fluid hysteroscopy is helpful in diagnosing chronic endometritis (CE) and the findings include:[47][8]

Treatment

Medical Therapy

Patients with chronic endometritis (CE) are treated with:

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy


References

  1. Template:DorlandsDict
  2. Hubert Guedj; Baggish, Michael S.; Valle, Rafael Heliodoro (2007). Hysteroscopy: visual perspectives of uterine anatomy, physiology, and pathology. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 488. ISBN 0-7817-5532-8.
  3. Cohen CR, Manhart LE, Bukusi EA; et al. (2002). "Association between Mycoplasma genitalium and acute endometritis". Lancet. 359 (9308): 765–6. doi:10.1016/S0140-6736(02)07848-0. PMID 11888591. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 4.2 Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA; et al. (1990). "Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis". Am J Surg Pathol. 14 (2): 167–75. doi:10.1097/00000478-199002000-00008. PMID 2137304.
  5. Greenwood SM, Moran JJ (1981). "Chronic endometritis: morphologic and clinical observations". Obstet Gynecol. 58 (2): 176–84. PMID 7254729.
  6. 6.0 6.1 Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S; et al. (2008). "Association of tuberculous endometritis with infertility and other gynecological complaints of women in India". J Clin Microbiol. 46 (12): 4068–70. doi:10.1128/JCM.01162-08. PMC 2593260. PMID 18842939.
  7. Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL; et al. (2011). "Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research". Pathol Res Pract. 207 (11): 680–5. doi:10.1016/j.prp.2011.08.007. PMC 3215901. PMID 21996319.
  8. 8.0 8.1 8.2 Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L; et al. (2008). "Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies". Fertil Steril. 89 (3): 677–84. doi:10.1016/j.fertnstert.2007.03.074. PMID 17531993.
  9. Cicinelli E, De Ziegler D, Nicoletti R, Tinelli R, Saliani N, Resta L; et al. (2009). "Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis". Gynecol Obstet Invest. 68 (2): 108–15. doi:10.1159/000223819. PMID 19521097.
  10. Kitaya K, Matsubayashi H, Takaya Y, Nishiyama R, Yamaguchi K, Takeuchi T; et al. (2017). "Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure". Am J Reprod Immunol. 78 (5). doi:10.1111/aji.12719. PMID 28608596.
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  17. Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C (2016). "Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis". Fertil Steril. 105 (1): 106–10. doi:10.1016/j.fertnstert.2015.09.025. PMID 26456229.
  18. Moyer DL, Mishell DR, Bell J (1970). "Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD". Am J Obstet Gynecol. 106 (6): 799–809. doi:10.1016/0002-9378(70)90470-9. PMID 4984305.
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  33. Eckert LO, Hawes SE, Wölner-Hanssen PK, Kiviat NB, Wasserheit JN, Paavonen JA; et al. (2002). "Endometritis: the clinical-pathologic syndrome". Am J Obstet Gynecol. 186 (4): 690–5. doi:10.1067/mob.2002.121728. PMID 11967492.
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  39. Bayer-Garner IB, Nickell JA, Korourian S (2004). "Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis". Arch Pathol Lab Med. 128 (9): 1000–3. doi:10.1043/1543-2165(2004)128<1000:RSIAIT>2.0.CO;2. PMID 15335255.
  40. McQueen DB, Perfetto CO, Hazard FK, Lathi RB (2015). "Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss". Fertil Steril. 104 (4): 927–931. doi:10.1016/j.fertnstert.2015.06.044. PMID 26207958.
  41. 41.0 41.1 41.2 Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA (2003). "CT of the acute abdomen: gynecologic etiologies". Abdom Imaging. 28 (3): 416–32. doi:10.1007/s00261-002-0052-0. PMID 12719915.
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