Definition: Accumulation of pus in uterine cavity, caused by interference with natural drainage of uterus is pyometra.
First case was described by John & Clarke of London in 1812. Attention was drawn by Whiteley and Hemlat l (1971) of more frequent association of pyometra with benign as compared to malignant disease of genital tract.
Diversity in methods of management of these cases indicate that a logical approach is needed for their management.
Attention is focused to review on etiology, improving clinical diagnosis, applying newer technology and early diagnosis .
It can also occur secondary to intrauterine infection. Actinomycotic pyometra has been reported as a complication of a forgotten intra-uterine device. Recently there has been an increase in genital tuberculosis, and this occasionally presents with pyometra.
Most women are treated with dilation of the cervix and drainage, with regular monitoring to detect recurrent or persistent disease. Antibiotics are only necessary if there is evidence of invasive infection, in the form of generalized malaise, pyrexia, or altered laboratory parameters.
If antibiotics have to be used, preparations covering aerobic and also anaerobic bacteria should be used,
Current research is focused on a group of drugs called carbapanems, which have an exceptionally wide spectrum of activity. Tubercular pyometra should be treated with appropriate anti-tubercular chemotherapy.
When cause of pyometra was malignant or other specific disease management is as per case.
Management of pyometra because of senile endometritis – Panhysterectomy within one month under routine antibiotic coverage. Those not fit for surgery medical management by prolonged cyclic oestrogen therapy (premarine0.625 mgm daily) for 4-6 months.
The prognosis in pyometra will depend both on the underlying cause (e.g. malignancy) and of the possibility of spontaneous perforation. Prompt recognition and treatment of the condition improves the prognosis considerably.