Endometritis resident survival guide: Difference between revisions

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❑ [[Complete blood count]] : A [[leukocytosis]] of 15000 to 30000 cells/microL is commonly seen.<br><br>
❑ [[Complete blood count]] : A [[leukocytosis]] of 15000 to 30000 cells/microL is commonly seen.<br><br>
❑ [[Cervical]] [[cultures]] taken before [[antibiotic]] administration can be helpful for appropriate [[antibiotic]] selection.<br><br>❑ [[Vaginal]] [[cultures]] are often contaminated and can mislead to inadequate [[antibiotic]] coverage.<br><br>❑ [[Blood]] [[cultures]] should be obtained if there is a high enough clinical suspicion for [[sepsis]] or [[bacteremia]]. <br><br>❑ [[Ultrasound]] can be used to rule out retained products of [[conception]], [[infected]] [[hematoma]], and uterine [[abscesses]]. Patients with [[endometritis]], findings consist of a [[thickened]], heterogeneous [[endometrium]], intracavitary fluid, and foci of air<br><br>❑ [[Computed tomography]] can show the same positive findings as [[ultrasound]] plus possible [[perimetrium]] or intrauterine [[inflammation]] and [[infection]].</div>| | | | | | | |}}
❑ [[Cervical]] [[cultures]] taken before [[antibiotic]] administration can be helpful for appropriate [[antibiotic]] selection.<br><br>❑ [[Vaginal]] [[cultures]] are often contaminated and can mislead to inadequate [[antibiotic]] coverage.<br><br>❑ [[Blood]] [[cultures]] should be obtained if there is a high enough clinical suspicion for [[sepsis]] or [[bacteremia]]. <br><br>❑ [[Ultrasound]] can be used to rule out retained products of [[conception]], [[infected]] [[hematoma]], and uterine [[abscesses]]. Patients with [[endometritis]], findings consist of a [[thickened]], heterogeneous [[endometrium]], intracavitary fluid, and foci of air<br><br>❑ [[Computed tomography]] can show the same positive findings as [[ultrasound]] plus possible [[perimetrium]] or intrauterine [[inflammation]] and [[infection]].<ref name="pmid23345378">{{cite journal |vauthors=Plunk M, Lee JH, Kani K, Dighe M |title=Imaging of postpartum complications: a multimodality review |journal=AJR Am J Roentgenol |volume=200 |issue=2 |pages=W143–54 |date=February 2013 |pmid=23345378 |doi=10.2214/AJR.12.9637 |url= |issn=}}</ref><ref name="pmid11706213">{{cite journal |vauthors=Nalaboff KM, Pellerito JS, Ben-Levi E |title=Imaging the endometrium: disease and normal variants |journal=Radiographics |volume=21 |issue=6 |pages=1409–24 |date=2001 |pmid=11706213 |doi=10.1148/radiographics.21.6.g01nv211409 |url= |issn=}}</ref><ref name="pmid25041975">{{cite journal |vauthors=Laifer-Narin SL, Kwak E, Kim H, Hecht EM, Newhouse JH |title=Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging |journal=Curr Probl Diagn Radiol |volume=43 |issue=6 |pages=374–85 |date=2014 |pmid=25041975 |doi=10.1067/j.cpradiol.2014.06.001 |url= |issn=}}</ref><ref name="pmid22082769">{{cite journal |vauthors=Vandermeermd FQ, Wong-You-Cheong JJ |title=Imaging of acute pelvic pain |journal=Top Magn Reson Imaging |volume=21 |issue=4 |pages=201–11 |date=July 2010 |pmid=22082769 |doi=10.1097/RMR.0b013e31823d7feb |url= |issn=}}</ref></div>| | | | | | | |}}
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Revision as of 10:55, 12 March 2021


Endometritis Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Postpartum endometritis:
Postpartum endometritis is caused by bacteria ascending from the lower genital tract into the cervix during labor. These bacterias that are the vaginal microflora include:[1]

Chronic endometritis:
Common cause of chronic endometritis (CE) is an infection with microorganisms, including:[2][3][4]

Acute endometritis:
Acute endometritis may be caused by Chlamydia trachomatis and Neisseria gonorrhea.[5]

Risk factors associated with endometritis are

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Endometritis:[6][7]

Abbreviations: BP: Blood pressure; RR=Respiratory rate; HR=Heart Rate, PROM= Premature rupture of membranes; AFV= Amniotic fluid volume

 
 
 
 
 
 
Pregnant woman comes with Endometritis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history :

❑ Age of menarche

❑ Last menstrual period

❑ Is the menstrual flow normal? How many pads she has to use in a day?

❑ Is there any foul smell or colour change?

❑ How many days does the menstruation stay?

Contraceptive history for example oral contraceptives, intrauterine device

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions :

❑ Do you have painful periods or menstrual cramps or excessive pain during menstruation?

❑ Have you experienced pain during sexual intercourse?

❑ Is there any pain in pelvis or abdomen?

❑ Have you experienced low back pain recently which is not due to mechanical problems?

❑ Have you noticed irregular bleeding?

❑ Have you felt abdominal pain on urination?

❑ Is there any urinary symptoms not specified as with cycle (frequency, dysuria, haematuria, presumed urinary tract infection)?

❑ Is there any menstrual haematuria?

❑ Have you had any pain on defecation which is not due to haemorrhoids or anal fissure?

❑ Is there any rectal bleeding not due to haemorrhoids or anal fissure?

❑ Is there any cyclical extrapelvic pain?

❑ Have you experienced postcoitalbleeding?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look if the following symptoms are present :

Fever,the grade of the fever is often indicative of the severity of the infection.

Abdominal pain (commonly suprapubic in location)

❑ Foul-smelling and purulent lochia.

Tachycardia

Hypotension.

Sepsis, diarrhoea, pain out of proportion in case of endometritis caused by Group A Streptococcus which may develop into toxic shock and necrotizing fasciitis.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about previous obstetric history if she was previously pregnant :

❑ Ask about previous pregnancies including miscarriages and terminations.

❑ Length of gestation.

❑ Ask about mode of delivery.

❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform the physical examination :

Suprapubic and uterine tenderness are often present on abdominal and pelvic exams.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the laboratory tests:

Complete blood count : A leukocytosis of 15000 to 30000 cells/microL is commonly seen.

Cervical cultures taken before antibiotic administration can be helpful for appropriate antibiotic selection.

Vaginal cultures are often contaminated and can mislead to inadequate antibiotic coverage.

Blood cultures should be obtained if there is a high enough clinical suspicion for sepsis or bacteremia.

Ultrasound can be used to rule out retained products of conception, infected hematoma, and uterine abscesses. Patients with endometritis, findings consist of a thickened, heterogeneous endometrium, intracavitary fluid, and foci of air

Computed tomography can show the same positive findings as ultrasound plus possible perimetrium or intrauterine inflammation and infection.[8][9][10][11]
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Dos

  • To reduce the risk of endometritis caused by STIs [12]
    • Patient should practise safe sex, such as using condoms.
    • Patient should get routine screening and early diagnosis of suspected STIs, in both herself and partner.
    • She should finish all treatment prescribed for an STI.

Don'ts

  • The content in this section is in bullet points.

References

  1. Faro S (2005). "Postpartum endometritis". Clin Perinatol. 32 (3): 803–14. doi:10.1016/j.clp.2005.04.005. PMID 16085035.
  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.
  3. 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.
  4. 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.
  5. 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.
  6. Pugsley Z, Ballard K (June 2007). "Management of endometriosis in general practice: the pathway to diagnosis". Br J Gen Pract. 57 (539): 470–6. PMC 2078174. PMID 17550672.
  7. Olive DL, Schwartz LB (June 1993). "Endometriosis". N Engl J Med. 328 (24): 1759–69. doi:10.1056/NEJM199306173282407. PMID 8110213.
  8. Plunk M, Lee JH, Kani K, Dighe M (February 2013). "Imaging of postpartum complications: a multimodality review". AJR Am J Roentgenol. 200 (2): W143–54. doi:10.2214/AJR.12.9637. PMID 23345378.
  9. Nalaboff KM, Pellerito JS, Ben-Levi E (2001). "Imaging the endometrium: disease and normal variants". Radiographics. 21 (6): 1409–24. doi:10.1148/radiographics.21.6.g01nv211409. PMID 11706213.
  10. Laifer-Narin SL, Kwak E, Kim H, Hecht EM, Newhouse JH (2014). "Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging". Curr Probl Diagn Radiol. 43 (6): 374–85. doi:10.1067/j.cpradiol.2014.06.001. PMID 25041975.
  11. Vandermeermd FQ, Wong-You-Cheong JJ (July 2010). "Imaging of acute pelvic pain". Top Magn Reson Imaging. 21 (4): 201–11. doi:10.1097/RMR.0b013e31823d7feb. PMID 22082769.
  12. "Endometritis: Causes, Symptoms, and Diagnosis".


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