Quick revision on topic of endometritis for medical students.

1. ENDOMETRITIS

2. INTRODUCTION Endometrium is protected from infection due to –
• Vaginal and cervical defense
• Periodic shedding of endometrium.
During child bearing period infection hardly occurs in the
endometrium except in septic abortion or puerperal sepsis
and acute gonococcal infection.

3. ACUTE
ENDOMETRITIS
• Almost occurs after abortion
or childbirth.
• Anaerobic streptococcus
• Staphylococcus pyrogenes
• Non-haemolytic streptococcus
• E-coli
• Bacteroides group
• Malnutition, unhygienic
environment,
AETIO-
PATHOGENESIS

4. CHRONIC
ENDOMETRITIS
• The infection occurs when
there is persistent source of
infection in the uterine cavity.
• IUCD, infected polyp, retained
products, uterine malignancy
and endometrial burns due to
radium.
• Tubercular endometritis is
chronic from the beginning.
AETIO-
PATHOGENESIS

5. Purulent or sero-purulent vaginal discharge.
Low grade fever
Weakness, anemia
Infertility
Menstrual abnormality
Vulval or vaginal ulcers
ENDOMETRITIS
CLINICAL
FEATURES

6. ENDOMETRITIS
INVESTIGATIONS • WBC & ESR raised
BLOOD
• Positive test with high dilution
MONTOUX TEST
• Taken for evidence of healed or active pulmonary
lesion
CHEST X-RAY
• Done during the week preceding menstruation, so
that tubercles are likely to come to the surface
DIAGNOSTIC UTERINE CURETTAGE

7. ENDOMETRITIS
INVESTIGATIONS
• Cultured for tubercle bacillus
SPUTUM & URINE
• From lesion in cervix, vagina or vulva
BIOPSY
• In a proved case it is contraindicated, but it’s a routine
investigation of infertility
HYSTEROSALPINGOGRAPHY (HSG)
• Abdominal & pelvic ultrasound, CT or MRI
IMAGING
• For identification of tubercle or segmented nodular
appearance of the tubes
LAPROSCOPY

8. ENDOMETRITIS
DIAGNOSIS
&
TREATMENT
DIAGNOSIS
• Diagnosis is made by cervical smear,
culture of discharge, transvaginal
ultrasonography and histology of
the endometrium.
TREATMENT
• The offending cause is to be
removed or eradicated.
• Antibiotic

9. ATROPIC
ENDOMETRITIS
• Following menopause, due to deficiency of
estrogen, the defense of the uterovaginal
canal is lost.
• There is no periodic shedding of the
endometrium.
• So organisms can ascend up to infect the
atrophic endometrium.
• Intense infiltration of the endometrium with
polymorph nuclear leukocytes and plasma cells
• The endometrium is ulcerated at places and is
replaced by granulation tissue.
• The purulent discharge either escapes out of
the uterine cavity or may be pent up inside
producing pyometra.

10. ATROPIC
ENDOMETRITIS
CLINICAL
FEATURES
• Postmenopausal women complain of vaginal
discharge, at times offensive or even blood -
stained.
• Pelvic exam - reveals features of vaginal
atrophic vaginitis.
• Purulent discharge may be seen escaping out
of the cervix.

11. ATROPIC
ENDOMETRITIS
DIAGNOSIS • The diagnosis is confused with carcinoma of
endometrium which must be excluded prior to
treatment.
• USG
• Diagnostic curettage shout be done and the
endometrium subjected to histological
examination.
• If pyometra is present, drainage of pus by
simple dilatation should be done first,
• After 1-2 weeks, diagnostic curettage is to be
done under cover of antibodies.

12. ATROPIC
ENDOMETRITIS
TREATMENT
• In women with recurrent attacks,
hysterectomy should be done and the
specimen should be subjected to
histological examination.

13. THANK YOU