Diagnosis of an inflammation of the uterus
A first indication of an inflammation of the uterine body can be abnormalities of the menstrual period, especially if they occur, for example, in connection with surgical vaginal procedures. If the myometrium is affected, the uterus is also painful and enlarged during the clinical examination. The smear (the so-called native preparation), which should be taken during the gynecological examination, shows a leukocyte-rich discharge, which is an indication of inflammation.
In addition, the smear can also be sent to a laboratory in order to determine the triggering pathogens by culture. Taking a blood sample to check the inflammation parameters usually does not help in making a diagnosis. However, the real evidence of an inflammation of the uterine body can only be obtained by taking a tissue sample. This tissue sample can be obtained in the course of a scraping (curettage or abrasio). If the menstrual cycle is disturbed, it should be carried out without fail, as these are not only symptoms of an inflammation, but may also be an indication of cancer.
Therapy of an inflammation of the uterus
If the uterine body is inflamed, it can in rare cases extend to the fallopian tubes or even the ovaries. This so-called salpingitis or pelvic inflammatory disease causes a strong feeling of illness in the affected patients.
Special forms of endometritis – Foreign body endometritis
Foreign body endometritis can develop in women who wear an intrauterine device (IUD), i.e. a coil. Women who have not yet had children and are under twenty years of age have the highest risk of developing inflammation. But even after giving birth there is still an increased risk.
This is further increased by a promiscuous lifestyle. The type of coil also has an influence on the risk of infection. For example, women who wear a spiral wrapped with copper wire (copper spiral) are significantly more at risk than women with a hormone spiral (e.g. Mirena).
To prevent an infection caused by a coil, a genital infection should be excluded before inserting the coil. If an infection is detected, the IUD should only be inserted after adequate treatment and complete healing. After successful positioning of the IUD, localization and inflammation parameters should be checked.
If this reveals abnormalities that indicate an inflammation, the intrauterine device should be removed. Since the risk is significantly increased in adolescents, the insertion of a coil should not be performed lightly. Senile endometritis occurs in advanced age.
In half of the patients there is an inflammation of the endometrium and a cancer of the endometrium (endometrial carcinoma). The trigger for senile endometritis is an adhesions of the inner cervix, for example after an inflammation of the cervix or due to new formations, which hinder the flow of the secretion from the uterine body. Consequently, it accumulates in the body of the uterus.
In this case one speaks of a serometra. If the secretion is purulent, it is no longer called serometra, but pyometra. In addition, irradiation within the uterus (intrauterine) can also be the reason for retention of the secretion.
Affected patients complain of intense pain in the lower abdomen, which can have a contraction-like character. Fever, a pressure-painful uterus and a purulent blood discharge can also be observed with partial drainage of the secretion. The therapeutic goal is to restore the outflow of the secretion.
This is achieved by expanding and inserting a so-called Fehling tube into the cervix. Antibiotic treatment is also indicated. After the disappearance of signs of inflammation, a scraping (curettage or abrasio) must be performed to rule out cancer.
Endometritis puerperalis is an inflammation of the lining of the uterus that occurs in the postpartum period, i.e. in the period immediately after birth up to six to eight weeks after birth. Endometritis puerperalis can also be caused by a miscarriage or an improperly performed abortion. It is the most common cause of puerperal fever.
Endometritis puerperalis is caused by bacteria that rise through the vagina into the body of the uterus. In most cases, the infection is caused by a combination of different bacteria (mixed infection). The most common are ß-hemolytic streptococci, staphylococci, enterococci, Escherichia coli and Proteus.
Promoting the rise of the bacteria are Patients with endometritis in the puerperium complain of a foul-smelling postpartum discharge. As the disease progresses, a high fever also occurs. Complications arise from the spread of the inflammation.
At the beginning, the inflammation is local, but in the further course it also spreads systemically throughout the body, which in extreme cases can lead to blood poisoning (sepsis) with shock, blood clotting disorders and multiple organ failure. Due to these potentially serious complications, an adequate therapy is essential. In the case of endometritis puerperalis, this is initially carried out with contraceptives that promote the contraction of the uterus.
One such contractile agent is oxytocin, which is also responsible for the contractions of the uterus during delivery. If any material remains in the uterus, a scraping (curettage or abrasio) is necessary to remove these remains.It may also be necessary to widen the cervix so that the postpartum can flow off without any problems. No antibiotics need to be administered in the case of mild endometritis puerperalis.
However, if the inflammation has spread to surrounding structures, broad-spectrum antibiotics must be used to prevent further spread. In extreme cases with blood poisoning (sepsis), coagulation disorders and multiple organ failure, intensive medical monitoring and therapy is indicated.
- A premature rupture of the bladder,
- Constant vaginal examinations,
- A surgical vaginal delivery,
- A cesarean section,
- The retention of placental remains,
- A congestion of the weekly river.
