This document discusses endometritis, including acute, chronic, and atrophic types. Acute endometritis usually occurs after abortion or childbirth and is caused by various bacteria. Chronic endometritis results from a persistent infection in the uterine cavity caused by things like IUDs or retained products. Atrophic endometritis occurs in postmenopausal women due to loss of estrogen protection. Clinical features include vaginal discharge and abdominal or pelvic pain. Diagnosis involves tests like cervical smears, ultrasounds, and endometrial biopsies. Treatment involves removing the infection source and using antibiotics.

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.

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