endometritis

(en″dō-mĕ-trīt′is)

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[endo- + metritis]
Inflammation of the lining of the uterus. Organisms may migrate through the cervical canal along mucosal surfaces, piggyback on sperm, or be carried on tampons or intrauterine devices. The inflammation may be acute, subacute, or chronic. The disorder is most common among females of childbearing age. The woman is at highest risk for endometritis during the immediate postpartum period. Endometritis that is not associated with pregnancy may result from pelvic inflammatory disease or invasive gynecologic procedures.
SEE: puerperal endometritis

ETIOLOGY
Endometritis usually results from an ascending bacterial invasion of the uterine cavity. Common offenders include Staphylococcus aureus and group B streptococcus, both of which are present in normal vaginal flora.
SEE: pelvic inflammatory disease; SEE: toxic shock syndrome

SYMPTOMS
The woman usually presents with low, cramping abdominal pain, low back pain, dysmenorrhea, dyspareunia, and fever. Depending on the causative organism, a purulent, mucopurulent, or serosanguinous cervical discharge is seen on vaginal examination. In postpartum endometritis, lochia is foul-smelling. Bimanual palpation finds a tender, boggy uterus.
SEE: cervix uteri; SEE: endometrium; SEE: uterus

DIAGNOSIS
Culturing the causative organisms from lochia, cesarean or episiotomy incisional exudate, cervical swab or aspirated materials establishes the diagnosis.

TREATMENT
Antibiotic regimens that treat a broad spectrum of organisms (anaerobes, aerobes, sexually transmitted microorganisms) are used empirically.

PATIENT CARE
The patient should be made aware that the infectious process may spread beyond the endometrium, into the fallopian tubes, ovaries, pelvic perineum, pelvic veins, or pelvic connective tissue.
SEE: pelvic inflammatory disease

Standard precautions are used when caring for the patient. The patient is assessed for changes in the amount, color, odor, and consistency of vaginal discharge. Pain also is assessed and treated as prescribed. The patient is taught about the drugs used for treatment, their desired effects, and any adverse effects. In acute cases, the patient may be febrile; fever is treated with antipyretic drugs if it exceeds 101°F and with PO or intravenous (IV) fluids for hydration as required. The patient may be placed on bedrest in a semi-Fowler's position to facilitate dependent drainage. Vital signs should be monitored every 4 hours, and fluid intake and output recorded. Heat may be applied to the abdomen to improve circulation.

The varied consequences of endometritis are explained. They can include the need for surgery to relieve chronic pain or to manage acute infections that are unresponsive to antibiotic therapy, adhesions, tubal scarring, and infertility. The potential or actual loss of reproductive capabilities can devastate the woman's self-concept. All professional care providers must assist the patient to adjust her self-concept to fit reality and to accept any alterations in a way that promotes future health. The patient should abstain from sexual contact until treatment is complete, the sexual partner has also received treatment as appropriate, and follow-up testing has been done. Sterile technique should be maintained throughout all vaginal examinations. Some states require that chlamydial infections be reported to local public health authorities. All female patients should be taught correct perineal and hand hygiene to help prevent endometritis.

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