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Endometritis after delivery: causes, symptoms, diagnosis, treatment

Endometritis is an inflammatory process that is characteristic of the inner layer of the uterus - the endometrium. Women experience this disease as a result of intrauterine research, artificial abortion, but most often newly minted mothers suffer from it immediately after childbirth.

The uterine lining is called the endometrium. Its main function is to create appropriate conditions for fixing a fertilized egg. In addition, oxygen passes through the vessels of the mucous membrane of the reproductive female organ to the unborn baby. Therefore, it is so important that the endometrium is restored after birth without any consequences. One of these consequences - endometritis after childbirth, will be discussed in this article.

What is it: endometritis after childbirth?

Endometritis is an inflammatory process that is characteristic of the inner layer of the uterus - the endometrium. Women experience this disease as a result of intrauterine research, artificial abortion, but most often newly minted mothers suffer from it immediately after childbirth. Postpartum endometritis may adversely affect subsequent pregnancies. Indeed, during the carrying of the baby it is very important that the work of the uterine mucosa be complete.

During the entire menstrual cycle, the endometrium changes its structure in order to create favorable conditions for fixing the fertilized egg. If the pregnancy does not come, then the inner mucous membrane of the uterus begins to reject. As a result, women have a blood discharge every month.

Inflammation of the uterus after childbirth disrupts all the processes occurring in it when it is healthy. Subsequently, women are faced with various kinds of complications: both when trying to conceive and when carrying a baby.

According to statistics, after vaginal delivery, 2–5% of parturient women experience endometritis; the probability of uterus inflammation during cesarean section is slightly higher and amounts to 10–20%.
This disease has ICD code 10 - 086 Other postpartum infections.

Causes and factors of the occurrence and development of postpartum endometritis

The structure of the endometrium combines two layers of mucous: basal and functional. The latter, as mentioned above, is rejected at the end of each menstrual cycle. Basal - subsequently forms a new functional layer.

It is the damage of this structure that can become the primary source of the inflammatory process. However, it is worth noting that endometritis does not occur after mucosal injuries, which is typical during labor, but due to penetration of pathogenic bacteria and viruses into the structure of the inner layer of the uterus.

The causative agents of the disease most often are:

• protei
• E. coli,
• Klebsiella,
• enterobacter,
• chlamydia,
• tuberculous microbacterium,
• mycoplasmas
• diphtheria stick,
• Streptococcus group B.
A significant role in the manifestation of the inflammatory process of the uterus is assigned to the immunological protection of the body. At the end of the third trimester of pregnancy, this function loses its abilities and resumes only 5–10 days later (depending on the type of delivery) after delivery.

The likelihood of developing endometritis after birth increases:

1) concomitant diseases of the body,
2) non-compliance with the rules of hygiene,
3) the presence of chronic foci of infection,
4) use of intrauterine types of contraception before pregnancy,
5) acute infectious diseases suffered during the childbearing,
6) placental remains in the uterus,
7) invasive (intrauterine) diagnostic methods during pregnancy, etc.

Endometritis can occur during childbirth. In this case, provoke the development of inflammation can: anhydrous period of up to 12 hours, abnormal blood loss, manual separation of the afterbirth, cesarean section.

These factors alone can not cause the onset of endometritis, but a combination of several - increases the likelihood of developing the disease several times.

Symptoms of postpartum endometritis

Signs of endometritis after childbirth have an unpredictable pattern of development. Symptoms of the disease can manifest itself in the first few hours after childbirth, and after 2 months. And it is good if a woman encounters the inflammatory process while still in the hospital, under the strict supervision of doctors. Otherwise, women in labor should independently monitor their own health. However, it is worth noting that the earlier the first signs of endometritis appear, the easier it will be to undergo therapy.
Although, even a mild course of the disease, sometimes, can turn into serious consequences, including infertility.

The first sign of a violation of the functionality of the uterine mucosa is an increase in temperature, with severe inflammation, mercury in a thermometer can reach 40-410С. In addition, the woman feels weakness, chills, headache.
It is important to know! Rising temperatures and fatigue may be associated with the process of the arrival of milk. In order not to confuse the beginning of the lactation period with a serious disease, you should constantly be in touch with a qualified specialist who will help you not to miss the symptoms of endometritis.

Further development of the disease is often accompanied by pulling constant pain in the lower abdomen and lumbar region, which increase during lactation.
Changes in the structure of the uterine mucosa and on the nature of postpartum discharge are reflected. Normally, in the first 2-3 days after birth, there is abundant bleeding. Subsequent discharge decreases in quantity, they become, first brown, then yellow, and by the end of 6-8 weeks they disappear altogether.

Endometritis causes excessive bleeding, or it resumes some time after birth. Allocation during inflammation and have a characteristic unpleasant odor, as well as may have a greenish, yellowish tint.

The etiological picture of the disease is also presented by slowing down the process of uterine contraction, which can be observed by palpation by a specialist or by ultrasound.

Endometritis after cesarean section

The likelihood of an inflammatory process in the uterus and beyond its chapels depends on the urgency of the operation. If a cesarean section was performed in an unplanned manner, the risk of encountering a serious illness can be from 22 to 85%. At the same time, inflammation almost always occurs in a severe form, due to direct infection of the uterus cavity.

Endometritis in this case is characterized by a high rate of spread not only in the reproductive organ, but also beyond its chapels, which can result in the development of lymphadenitis (inflammation of the lymphatic system nodes), myometritis (inflammation of the uterine muscle layer) and other dangerous diseases.

The inflammatory process often manifests itself already 1-2 days after surgery. To the listed symptoms, which are observed in endometritis after natural childbirth, a violation of the healing process of the dissected uterine wall is added. The nature of the discharge, sometimes, takes a pussy, muddy character.

The course of the disease may aggravate intestinal paresis during cesarean section. Accordingly, the barrier function is violated, the properties of which consist in opposing the penetration of microbial flora into the abdominal cavity.
Given that the etiology of endometritis is similar to many other consequences of delivery, an accurate diagnosis can be made only after a thorough diagnosis.

Diagnosis of Endometritis

When the woman is still in the maternity hospital, experts carefully monitor the fluctuations that increase the temperature, the nature of the discharge, as well as the process of uterine contraction. Therefore, to diagnose - endometritis after childbirth in women in the hospital is easier.
Suspecting the development of the disease, the mother is prescribed a general blood test, which gives a picture of the signs of infection: an increase in the number of leukocytes and a decrease in hemoglobin to critical values.

In addition, an ultrasound scan makes it possible to detect abnormalities in the size of the uterus during the normal course of contraction, a decrease in its tone, the presence of placental debris, and to detect enhanced endometrial blood flow after delivery. If the ultrasound did not show any of the listed disorders in the body, and the woman still worries the symptoms of inflammation, a hysteroscopy is additionally prescribed.

This is a procedure during which a special optical device is inserted into the uterine cavity under the influence of local anesthesia. It provides an opportunity to inspect the surface of the body, as well as take tissue samples of the mucous for a detailed study.

Do not miss the beginning of the development of postpartum endometritis is much more difficult for women who have already been discharged from the hospital. In this case, the disease may be hidden for 2 weeks. A slight course of mucosal structure disorders may not even cause concern to the woman in labor. However, ignoring the symptoms can lead to sad consequences. Therefore, it is so important when the temperature rises without signs of Influenza or SARS to consult a gynecologist. It is desirable to those who led the pregnancy or watched you in the postpartum period.

Only the timely identification of the problem will save from terrible consequences.

Treatment of postpartum endometritis

The acute form of endometritis requires the use of antibacterial therapy. After all, infectious etiology often precedes inflammation.

Relief of acute manifestations of functional disorders of the mucous membrane allows you to proceed to the next stage of treatment - the administration of anti-inflammatory drugs, immunostimulants, and physiotherapy. In addition, oral contraceptives are prescribed for 3-5 cycles.

In severe forms, endometritis and breastfeeding are not compatible. But a light inflammation allows you to pick up drugs that will not penetrate into breast milk.

If endometritis after delivery has acquired a chronic form, the appropriate treatment starts from the first day of the cycle. A long-running process requires cyclic hormone therapy.
The surgical method of treatment is relevant only in case of complications of endometritis, the formation of polyps on the uterine mucosa. Scraping the upper shell together with polyps contributes to the renewal of tissues, as well as a favorable outcome during repeated pregnancy.

Treatment of folk remedies

Traditional medicine presents many recipes for treating endometritis. However, none of them guarantees you complete healing. With a light course, you can practice syringing infusions of medicinal herbs. To do this, in equal proportions mixed root Althea, oak bark, cuff. Then the mixture is poured 200 ml of boiling water and infused for one hour. These herbs can relieve pain and reduce the manifestations of the inflammatory process.

And yet it is better to seek help from a qualified specialist and not to self-medicate. After all, timely and proper treatment is the key to a quick recovery and prevention of complications of the disease.

Postpartum Endometritis: Effects and Prevention

Delayed and inappropriate treatment of endometritis can not only transform its acute form into a chronic one, but also lead to serious consequences. One of the most dangerous is metroendometrit, a lesion of the muscular layer of the uterus and its cervix. Therapy of this disease is a complex and unpredictable process. In addition, the defeat of the muscular layer of the uterus often ends in infertility.
Complications of violations of the functional shell of the female reproductive organ can be represented:

- the appearance of purulent cavities in the uterus,
- inflammation of the ovaries and fallopian tubes,
- overgrowth of the uterus with adhesions,
- peritonitis (inflammation of the peritoneum) and sepsis, in which the fatal outcome, sometimes inevitable,
- complications of subsequent pregnancy - miscarriage, premature birth.
Therefore, it is important to observe measures to prevent the development of endometritis. To do this, in the postpartum period, it is necessary to especially carefully follow the rules of hygiene: change disposable pads at least once every 4 hours, take a daily shower. It is not recommended to use tampons before resuming the menstrual cycle. Until the end of postpartum discharge, unprotected sex should be avoided.

What is endometritis?

Endometritis after childbirth adversely affects subsequent pregnancies, because for normal childbearing it is very important that the mucous membrane is complete.

During the menstrual cycle, the endometrium changes, as a result of which optimal conditions are created for the onset of pregnancy. If the pregnancy does not occur, the endometrial layer is rejected (displayed with menstruation), leaving only the germ layer. After the end of menstruation, the cells of the germ layer begin to divide, and the endometrium is again ready to receive the fertilized egg.

If after childbirth the genital organ becomes inflamed, then all the processes that occur in it are disturbed. A woman may develop various complications during the next attempts at conception.

If you turn to statistics, endometritis occurs in 2-4% of pregnant women, and after cesarean section the risk of developing pathology is even higher - 10-20%.

Etiology of the phenomenon

After birth, the intrauterine cavity is an open bleeding wound. Epithelial cells restore the inner layer of the reproductive organ in about a month and a half. Until that time, the risk of infection is very high. The causative agents of the inflammatory process are constantly present in the woman’s body, but they begin to actively reproduce only under certain conditions. Childbirth - these are the conditions under which the pathogenic flora becomes active.

The causes of endometritis after childbirth are different, but most often doctors distinguish the following:

  1. Reducing the immunity of women. The last weeks of pregnancy and some time after giving birth, the woman’s immunity is not in the best condition, therefore, it is difficult for the body to fight the infection itself. Restoration of the previous level of immunity takes several days - from 5 to 10, depending on the mode of delivery.
  2. Operational intervention in the genital organ. In addition to the fact that the immunity is reduced, the surgical incision is subjected to primary infection. After surgery, the uterus is reduced worse, and therefore self-cleaning is almost impossible, which increases the risk of endometritis of the uterus after childbirth.

Also contribute to the development of pathology:

  1. Chronic foci of infection in the body.
  2. Inflammatory processes of internal organs.
  3. Endocrine diseases and metabolic disorders.
  4. Endometrial injuries that have been triggered by prolonged use of intrauterine contraceptives, miscarriages, abortions or diagnostic curettage, pre-pregnancy.
  5. Complications during childbirth. Polyhydramnios, the threat of miscarriage, exacerbation of chronic diseases, isthmic-cervical insufficiency, acute infections, placenta previa - all this can give impetus to the development of endometritis after birth. In addition, invasive diagnostics, as well as the filing of the cervix can also provoke this disease.
  6. Complications during labor. Prolonged labor, a long anhydrous period, abundant blood loss, manual separation of the placenta and afterbirth, and so on.
  7. The birth of a baby infected in utero.
  8. Difficulties in the postpartum period. The causes of endometritis after childbirth may lie in violation of the rules of postpartum hygiene, too long bed rest, poor involution of the genital organ.

I must say that every single factor can not lead to endometritis, but in the aggregate the probability of developing the disease increases.

Signs of postpartum endometritis

In the female body, endometritis after childbirth can occur in an acute or chronic form. The clinical picture varies depending on the form of the disease. Acute endometritis after childbirth is accompanied by bright signs, which allows time to diagnose and treat the pathological process. In chronic form, the symptoms are blurred and mild. Often women do not attach importance to such symptoms, writing them off for the postpartum period, thereby delaying the visit to the gynecologist. Such negligence can lead to irreversible consequences.

In addition, the signs of endometritis after birth directly depend on the severity of the disease.

In case of mild symptoms, the symptoms begin to appear in the first week after delivery.

In this case, the endometritis after childbirth symptoms will have the following:

  • fever,
  • tachycardia,
  • увеличение размеров матки, болевые ощущения в месте локализации лимфатических узлов,
  • длительные кровянистые выделения,
  • sometimes secretions accumulate in the cavity of the reproductive organ.

A severe form of the disease clinically begins to manifest itself in the first 2-3 days after birth. Most often, severe disease is observed after a difficult childbirth or operation.

In this case, the endometritis after childbirth symptoms will have the following:

  • purulent resorptive fever,
  • pain in the uterus,
  • pus in lochiah
  • discharge goes from uterus to pyometra,
  • anemia.

In addition, the symptoms of endometritis in women after childbirth are manifested in the deterioration of the general condition:

  • weakness,
  • headaches,
  • loss of appetite
  • insomnia,
  • pain in the lower abdomen.

Acute endometritis

As already mentioned, the symptoms and treatment of endometritis in women after childbirth depend on the form of the pathology.

In acute endometritis, a woman complains of the following symptoms:

  • very high temperature - up to 39 degrees,
  • pain in the lower abdomen, which can be given to the sacrum area,
  • bloody purulent, serous or serous purulent discharge,
  • general weakness and weakness.

It is very important to pay attention to the selection. Normally, after childbirth, bleeding may occur for a couple of days, then their number gradually decreases, they turn brown or yellowish. By about the eighth week, all discharge stops completely. Acute endometritis is accompanied by abundant secretions, and in the presence of pus, they may turn green.

Diagnostic measures

Treatment of endometritis after birth should begin after a thorough diagnosis:

  1. Interviewing the patient about symptoms and complaints, as well as collecting information about past infectious diseases.
  2. General examination - measurement of pulse, temperature and blood pressure, as well as palpation of the uterus.
  3. Examination of the cervix in the gynecological chair.
  4. Palpation of the uterus to determine its size and degree of pain.
  5. Ultrasound of the uterus - provides information on the presence of placenta and blood clots in the genital organ, and also indicates its exact dimensions.
  6. Laboratory tests - blood, smear, bakposev.

Principles of treatment

Treatment of endometritis after childbirth can be carried out conservatively or surgically.

If at the time of the onset of the disease, the woman has not yet been discharged from the maternity hospital, she is transferred to a special ward, where there are women who have some kind of postpartum complications. If a woman has found signs of endometritis at home, she should be hospitalized in the gynecology department.

The main conservative treatment of pathology is the use of antibacterial drugs. This necessarily takes into account that a woman is breastfeeding a baby. If the patient’s condition is severe, the issue of breastfeeding is reviewed.

In addition to antibiotic therapy, other drugs are prescribed:

  1. To improve the contractility of the uterus, oxytocin is administered after the administration of "No-shpy." At the same time, the outflow of uterine secretions improves, the area of ​​the wound surface is reduced, and the decay products are worse absorbed into the blood. Also, to improve the contractility of the reproductive organ, a cold heating pad may be administered to the uterus area.
  2. Immunocorrective drugs - Kipferon, Viferon, human immunoglobulin. If the patient has viral infections, antiviral agents are prescribed.
  3. Symptomatic therapy - painkillers.

In the chronic form of the disease therapeutic measures are as follows:

  • rehabilitation of the outbreak
  • removal of synechiae
  • hormone therapy aimed at stabilizing hormonal levels.

Physiotherapeutic procedures help to alleviate the course of the disease:

  1. Treatment by interference currents according to Nemec - the use of low and medium frequencies by means of four electrodes.
  2. Pulsed low-frequency currents - assigned for early rehabilitation.
  3. Acupuncture - simulates the functionality of the immune system.

As for the radical methods of therapy, in severe cases, prescribe:

  • hysteroscopy
  • vacuum aspiration
  • washing the cavity of the reproductive organ with antiseptics.

Such procedures are not carried out in the following cases:

  • septic shock,
  • failure of the suture after cesarean,
  • inflammatory processes outside the genital organ,
  • pelvioperitonitis or peritonitis.

Possible consequences

If timely treatment of endometritis is absent, metritis develops. Metroendometritis - inflammation of the basal layer of the endometrium and the myometrium adjacent to it.

Such a complicated disease is divided into three stages:

  1. Only the islands of the endometrium and the falling shell are affected. A reactive inflammatory process is observed in the uterine muscle layer - vessels expand, tissues swell, small-cell infiltration occurs.
  2. In addition to the above, the deeper layers are affected.
  3. Infectious lesion covered parametria and perimetry, developing pelvioperitonit.

The chronic form of metroendometritis almost always leads to infertility.

With a prolonged form of pathology, salpingitis and oophoritis may develop - the inflammatory process spreads to the fallopian tubes and ovaries.

In addition, the following dangerous pathologies can be complications of endometritis:

  • thrombophlebitis is an inflammatory process that affects blood vessels in the low-base area,
  • pelvic abscess - an infectious suppurative focus that has its own walls,
  • sepsis.

Preventive actions

To reduce the risk of developing postpartum endometritis, you must adhere to the following principles:

  1. Plan a pregnancy and get ready for it. A woman before the onset of pregnancy should identify and cure all chronic diseases of the gynecological nature.
  2. Get up to time in the women's clinic. The recommended period is up to 12 weeks.
  3. Regular preventive examinations of an obstetrician-gynecologist. In 1 trimester, this should be done once a month, in 2 trimester - once every 2 weeks, and in 3 trimester - once a week.
  4. Follow the rules of diet. The diet of a pregnant woman should be moderate in carbohydrates and fats and sufficient in protein. It is recommended to exclude fatty, fried, sweet and flour, to consume more dairy products, meat and legumes.
  5. Engage in physical therapy for pregnant women. Showing minor exercise - walking, stretching, breathing exercises. Need to do about half an hour a day.

Equally important in the prevention of postpartum endometritis correctly plays a delivery:

  1. It is necessary to evaluate indications and contraindications for natural childbirth or for cesarean section.
  2. Inspection of the placenta for tissue defects and integrity.
  3. Introduction of antibacterial drugs for prolonged anhydrous course of labor, as well as for caesarean section.

Conclusion and conclusions

With regard to prognoses of postpartum endometritis, a mild and moderate form of the disease with a competent approach to treatment ends with recovery and full preservation of reproductive function. In severe decompensated form, complications are possible - septic conditions, loss of the genital organ, and even death. That is why doctors strongly recommend expectant mothers to be attentive to their health both before and after childbirth. Proper preparation for pregnancy, proper management, compliance with all rules during delivery, as well as postpartum prophylaxis of endometritis are the main precautions that will reduce the likelihood of developing endometritis and allow the woman to fully enjoy her motherhood.

Probable complications after cesarean

The outcome of delivery through surgery is very individual, therefore it is rather difficult to predict. The professionalism of doctors and well-thought-out rehabilitation minimize the risk of complications, but there are always exceptions, so endometritis after cesarean and other complications do occur.

  • Severe blood loss is considered the most common complication, which is quite typical for cesarean. Indeed, during this procedure, the dissection of tissues. For comparison: during natural childbirth, a woman loses about a glass of blood, and for caesarean section - up to one liter. Therefore, after a labor-giving operation, the puerperal is given an IV to replace lost blood.
  • Peristalsis of the intestine is disturbed in many women after cesarean, but all intestinal functions recover quickly enough. Compliance with the regime, activity and thoughtful nutrition will help mom quickly recover.
  • Adhesions after cesarean is also a fairly common complication that causes functional impairment in many intraorganic structures. To avoid adhesions, women are advised to move more, to undergo a preventive course of physiotherapy.
  • Problems with the seam. They consist of bleeding, inflammation, seam divergence. The reason for such problems is often the wrong technique of imposition, violation of the rules of suture, lifting weights, etc. There may be late complications such as keloid scars, hernial lesions or ligature fistulas. Such pathologies require compulsory treatment, which is often surgical in nature.

Women after caesarean may be disturbed by various complications, but in this article I would like to take a closer look at such pathology as endometritis after caesarean.

Postpartum Endometritis

Postpartum endometritis is called an inflammatory lesion of the mucous uterine layer. Usually, this complication occurs in a rather mild form, but in 25% of cases it is characterized by a severe course. The development of endometritis is caused by the penetration into the uterus of an infectious pathogen. To avoid this complication, puerperal women after cesarean are prescribed a prophylactic course of antibiotic therapy.

Endometritis can occur not only after a delivery operation, but also as a result of traditional, natural births. In this case, pathogenic pathogens penetrate into the uterus through the cervical canal, and not through a dissection, as in cesarean.

Endometritis

Endometritis can develop in several forms: classical, erased, or abortive. Classic postpartum endometritis begins to manifest itself on the first or fifth day of the postpartum period with purulent secretions, hyperthermia, a painful stomach, bloating, contraction of urination, lack of defecation, etc.

Abraded endometritis forms in late periods, at the end of the first postpartum week. It is characterized by a wave-like course, then remission, aggravation, accompanied by a slight soreness in the uterus and slightly elevated temperature (not more than 38 ° C). There is also an abortive form, which occurs 2-4 days after delivery. Such endometritis is characterized by manifestations of classic symptoms, which, with proper treatment, are quickly eliminated.

Causes of pathology

A cesarean section causes a number of specific circumstances that negatively affect the condition of the woman. When dissecting the peritoneum and uterine wall, microorganisms and various bacteria can easily penetrate inside. If the seam is infected, the inflammatory process can move to the rest of the organ. All this greatly complicates the course of postpartum endometritis.

Fungal, parasitic, viral and bacterial agents can provoke endometritis. Most often, after caesarean, endometritis is caused by conditionally pathogenic bacteria like streptococci and staphylococci, as well as venereal pathogens such as mycoplasmas, chlamydia and gonococci. Rarely provoke pathology anaerobic bacteria.

Sometimes the female body rejects the material with which the suture was performed, as a result of which the infection develops. Healing of the suture is delayed, which negatively affects the process of uterine contraction. Due to the lack of contraction, lochia accumulate in the organ, which create favorable conditions for bacteria. Which also contributes to endometritis. As a result of surgical delivery, the patient experiences a deficiency in the hormones of the glucocorticosteroid group, which causes a decrease in the immune status and contributes to the development of infectious processes.

Experts note and common factors that provoke the development of postpartum endometritis, regardless of the method of delivery. These include polyhydramnios during pregnancy and pathologically low immune protection (immunodeficiency states), excessive blood loss during delivery, as well as violation of antiseptic and septic requirements during labor and the postoperative period. To provoke the development of endometritis after cesarean section can pathology, which actually was an indication for cesarean. These include exchange failures, pulmonary and renal diseases, diabetes, etc.

Also provoke inflammation of the endometrium may be postoperative injuries and incomplete prenatal medical examination, the presence of unhealthy habits and poor nutrition, history of miscarriages and abortions, long-term wearing of the intrauterine device, etc.

Symptoms of postpartum endometritis

Endometritis after cesarean section begins to show symptoms on the second day of the postpartum period. Pathology is characterized by the following symptoms:

  • Noticeable hyperthermia,
  • Abdominal soreness, nausea, weakness and chills, migraines,
  • Heart rate is increasing,
  • Discharges become turbid, become watery and disgusting smell, often with impurities of purulent character,
  • Sometimes there is some swelling seam,
  • The amount of uterine secretions increases,
  • It begins to disturb constipation, bloating and problems with urination,
  • Palpation is marked by tenderness in the uterus,
  • During the day, temperature indicators are constantly changing
  • Contractions of the uterus are practically absent, and its cavity has more expanded dimensions,
  • Air clusters, extraneous substances are detected inside the uterus, deformation is observed in the suture area,
  • Blood tests show an increase in erythrocyte sedimentation rate and white blood cell count.

The likelihood of endometritis depends on the quality of the performed cesarean. In a planned operation, the risk of endometritis does not exceed 5-6%, and emergency intervention in 85% of cases results in inflammation of the endometrium. The danger of such endometritis is that it often proceeds quite hard. Initially, the infection develops against the background of the incision, which complicates the healing process of the suture. As a result, the uterus stops contracting, which impairs lochia output.

Quite often, the inflammatory process from the uterine lining extends to other layers and structures, causing the development of pathologies such as metrotromboflebit, lymphadenitis, myometritis, etc.

How to diagnose

Postpartum endometritis is diagnosed on the basis of data obtained after conducting obstetric-gynecological anamnestic studies and general examination, gynecological examination with mirrors and bimanual examination of the vagina, ultrasound diagnosis. Additional laboratory tests, such as microscopic analysis of a gynecological smear, hysteroscopic examination, blood tests and bacteriological seeding of uterine secretions, are also being conducted.

After cesarean

Cesarean section is not a risk factor for endometritis in puerperal women.

If after natural childbirth, pathology appears in seven percent of patients, then indicators of elective caesarean section are more modest - from 5 to 6 percent of complications manifest as postpartum inflammation of the mucous membrane.

Emergency cases of surgery are an exception - the statistics give a range of 25 to 85 percent of complications in the form of postpartum endometritis.

It is characteristic that endometritis after caesarean section is more difficult, since an additional traumatic factor is an incision in the skin, which opens the second gate for infection in the uterine cavity.

The onset of inflammation in the postpartum period is associated with the penetration of pathogenic microflora into the uterus. Most often, the infection gets ascending, as well as from the digestive organs.

In 90% of cases, doctors register enterobacteria, staphylococcus and streptococcus, anaerobic pathogens as infectious agents. Much less often can be identified chlamydia, gonococcus and mycoplasma.

A factor that provokes the appearance of pathology is a decrease in immunity.

The entire period of gestation of the fetus the body worked, first of all, to ensure the life of the child, so after birth the defenses are reduced.

You can also mention the qualitative change in the microflora of the vagina, which mainly occurs in the last trimester of pregnancy.

There is an imbalance between conditionally pathogenic microflora, some representatives go out of control, which leads to a shift in the dynamic balance of the pathogens living in the vagina.

Дополнительными факторами являются диагностические вмешательства – выскабливания, ранее проведенные аборты, ношение ВМС, осложнения в родовом процессе (стремительные или затяжные роды, разрывы промежности и т.д.).

Форма патологии

Pathology in the postpartum period can occur in several forms:

  • mild form - characterized by a weak onset of about 5-7 days after birth. The body temperature on average varies from 38 to 39 degrees, the pulse is speeded up, and occasionally there is a chill. In the area of ​​the uterus, there is soreness that lasts for about a week, the size of the organ is slightly increased,
  • severe form - the disease occurs as acute endometritis. The first signs of the disease appear already on the second day after birth. Often the occurrence of acute postpartum endometritis is preceded by a severe course of the birth process itself. Usually, the onset of the disease does not bring significant improvements, and after the first day after the onset of the pathology, the patient's condition worsens. Intoxication begins, patients complain of pain in the lower abdomen, lochia gradually get a dirty color due to the addition of purulent discharge.

Also, doctors emit another erased form of the disease. In this case, the pathology can manifest as in the first days after birth, and much later.

The symptoms of this form are not severe, the temperature almost never reaches 38 degrees.

Lochia at the initial stage is brown, and only then purulent discharge joins.

Uterus soreness can persist for up to two weeks - usually by this time the situation is normalized and the temperature drops to normal values.

Signs of endometritis after childbirth mainly depend on the severity of the course of the disease. In most cases, the disease occurs in a lightweight form.

Postpartum endometritis gives different symptoms, but all forms are characterized by the following symptoms:

  • fever,
  • soreness in the lower abdomen,
  • painful defecation due to tension in the abdominal wall,
  • a feeling of discomfort due to uterine edema,
  • increased heart rate
  • deterioration of the general condition
  • there is an admixture of pus in lochia, which changes the color of discharge.

Symptoms of postpartum endometritis usually subside by 10-14 days, depending on the severity of the pathology.

Physiotherapy

As physiotherapy, treatment of postpartum endometritis with low-frequency interference currents is used. Acupuncture is performed - the positive effect of acupuncture on the hemostatic system is proved.

Doctors also recommend external and intracavitary radiation to women in labor with the help of a low-intensity laser. The laser has analgesic, immunostimulating and anti-inflammatory effects.

Due to the effect of the laser, tissue edema is reduced, metabolic processes are activated, and local immunity is strengthened.

Pathogenic microflora becomes less active, and the sensitivity of pathogens to antibacterial drugs increases.

Folk remedies

Folk remedies for postpartum endometritis are used both inside as infusions and decoctions, and locally - in the form of irrigation of the uterus. For douching, you can use a solution of tannin.

As a drink, take a herbal infusion of Leuzei, dried flowers, Althea, clover, lavender, blueberries and nettle, as well as pine buds.

All ingredients are taken in equal quantities, and then two tablespoons of dry ingredients are poured with a liter of water and sealed overnight.

In the morning they drink a third of a glass of liquid three times a day. It is necessary to treat the pathology for at least two months.

Complications

Pathology with delayed treatment can provoke significant complications for a woman’s health.

The disease can become chronic, which is very difficult to cure. A dangerous complication is pyometra - accumulation of pus in the uterus, as well as pelvioperitonitis.

In some cases, the pathological process spreads to the fallopian tubes and ovaries. Significantly increases the risk of adhesions, there is also the possibility of blood infection.

Complications can lead to the need for complete removal of the uterus.

With the timely diagnosis of the disease, postpartum endometritis can be successfully cured, and a mild form of the pathology is best treated.

With a severe course of the disease, the prognosis is disappointing, if there are no significant improvements during the week, and the dynamics of the patient's condition worsens, then the question of the removal of the uterus is considered.

The main causes of pathology

Endometritis after a cesarean section occurs when microorganisms that can cause inflammation get into the operated uterus. Most often during the examination revealed the following options for microbial associations:

  • conditionally pathogenic vaginal microflora in women who have long and unsuccessfully treated bacterial vaginosis,
  • a mixture of common infections (Escherichia coli, staphylococcus, streptococcus, microorganisms living in an oxygen-free environment),
  • genital infections (chlamydia, gonococcus, mycoplasma, viruses).

A prerequisite for the development of an acute inflammatory process in the operated uterus is the presence of risk factors that provoke and promote infection:

  • complicated course of pregnancy (preeclampsia, threatened miscarriage, bleeding during pregnancy, preterm labor),
  • female pathology (diabetes mellitus, anemia, pyelonephritis, heart and vascular diseases, endocrine disorders),
  • thrush and bacterial vaginosis in the absence of treatment effect,
  • weakened immune defense
  • changes in the vascular system typical for pregnancy (tendency to increased clotting),
  • traumatic injuries during childbirth,
  • the urgency and urgency of the delivery operation,
  • unreasonable and uncontrolled use of antibiotics.

Inflammation inside the uterus after cesarean section occurs 5 times more often than after natural childbirth, so it is very important to strictly follow the recommendations of the doctor at all stages of gestation and preparation for delivery.

Options for inflammatory complications

The classification of postoperative uterus inflammation divides the disease into the following types:

  • true endometritis,
  • endometritis with necrosis of the uterine lining,
  • acute inflammation on the background of placental tissue residues.

According to severity, the following variants of endometritis after cesarean are distinguished:

The most dangerous is the erased and weak-symptom type of postpartum complications, occurring in the late period (7-12 days), when the happy mother discharged from the maternity hospital is fully occupied with the baby and does not pay attention to changes in her own state of health.

Signs of postpartum inflammation of the uterus

The severity of external manifestations depends on the severity of infection occurring inside the uterus. It is important to notice the following main symptoms in time:

  • increase in total body temperature
  • marked deterioration in general condition
  • constant pain in the uterus,
  • change in the type of vaginal discharge (purulent or tomato with an unpleasant odor).

With a hidden pathology and with a mild form of the disease, the temperature rarely rises above 37, 5-38 ° C. There will be no major changes in the general condition, and pain and blood from the vagina seem to be typical for this period of life.

Malosymptomaticity does not at all mean the absence of problems in the postoperative uterus: slowly progressive endometritis can be the basis for the progression of infection (parametritis, peritonitis, sepsis).

Severe intrauterine inflammation after delivery by cesarean section is manifested in the early period (2-4 days) by the following symptoms:

  • sharply rising temperature to 39–40 ° C,
  • heart palpitations
  • chills,
  • strong weakness
  • increasing pain in the uterus,
  • extremely unpleasant-looking vaginal discharge.

Usually at this time the woman is in the maternity hospital, so the examination and treatment is carried out as quickly and efficiently as possible.

Diagnostic tests

On examination, the doctor will definitely pay attention to the condition of the mammary glands (against the background of lactostasis, a temperature reaction always occurs), the type of vaginal discharge, the size of the postpartum uterus and the state of the postoperative scar on the abdomen. Usually this is enough to suggest an acute inflammatory process.

In addition to the standard examination of the doctor, it is necessary to pass general clinical tests, take a bacterial culture of the discharge from the uterus and do an ultrasound scan. Basic ultrasound criteria for endometritis:

  • an increase in volume and anteroposterior size,
  • the uneven contours of the inner lining of the uterus,
  • the presence within the uterine cavity of excess formations of irregular shape and without clear contours.

If a necrotic pathology is suspected, or if there are residues of placental tissue in the cavity, it is necessary to perform hysteroscopy for diagnostic and treatment purposes.

Medical tactic

From the time of diagnosis, it is necessary to immediately begin the following therapeutic measures:

  • ingestion or intramuscular administration of broad-spectrum antibiotics (at least 2 drugs with the mandatory correction of drugs after obtaining the result of seeding),
  • removal of inflammatory intoxication using droppers,
  • symptomatic drug therapy,
  • local treatment (careful and careful removal of necrotic masses and placental tissue residues from the cavity, performed during hysteroscopy).

One of the main problems in the treatment of postoperative endometritis in women in the early postpartum period is the need to temporarily refuse breastfeeding, because antibacterial treatment should be started as quickly as possible.

In rare cases, against the background of a particularly severe course of postoperative endometritis and at high risk of developing sepsis with a threat to the life of a woman, an operation should be performed to remove the uterus, as a focus of purulent inflammation.

Prevention of complications after delivery

To prevent a woman’s life-threatening inflammation in the uterus after a cesarean section, the following recommendations should be followed:

  • at the pregravid preparation stage, examine and get rid of chronic infections, cure dental caries,
  • strictly follow the doctor's advice on the treatment of colpitis, cervicitis, cystitis, pyelonephritis and bacterial vaginosis at all stages of gestation,
  • conduct effective therapy of common and infectious diseases.

In childbirth, much depends on the urgency of the situation: if necessary, an urgent and unplanned operation increases the risk of complications, therefore, if there are indications, one should prepare for a planned operative delivery.

Surgery to remove a child from the uterus is always carried out according to indications. Some women do not want to experience maternal pain and require caesarean section, but the desire of the pregnant woman is not a reason for choosing the operative method of delivery. Natural childbirth is painful, but safer for mother and baby. A cesarean section can be a cause for endometritis, which dramatically increases the risk of fatal sepsis with the need for surgical removal of the uterus.

Differences in the forms of endometritis

Medicine knows two forms of endometritis: acute and chronic. Symptoms of the acute form are pronounced. They can quickly diagnose the disease. Symptoms in chronic form - sluggish current, pathology is difficult to identify. Endometritis after birth can take one or the other form.

The disease begins its development at 5-8 days after birth. Some signs say that the pathology has taken a slight form:

  • body temperature rises sharply
  • quickens the pulse
  • the uterus increases in size, there is its pain,
  • in some cases, there is an accumulation of discharge in the uterine cavity.

Severe postpartum endometritis has slightly different symptoms, they occur earlier, as early as 2-3 days after delivery:

  • purulent fever develops,
  • uterine tenderness becomes incredibly strong
  • there is a strong chill,
  • tachycardia is possible,
  • pus is formed in lochia,
  • the course of the disease is accompanied by anemia.

The general condition of the woman leaves much to be desired. This is noticeable by the weakness of the body, by the fact that the appetite is disturbed, severe headaches occur, and lower abdomen hurts.

There are strong changes in the lochia, they become turbid, watery, abundant, with an admixture of pus.

In addition, there are three more forms of postpartum endometritis:

  • classical - the condition of the woman in labor is significantly worsening already at 1-5 days. It is characterized by the occurrence of chills, fever. Vaginal discharge is purulent, weakness, dry skin,
  • abortive - becomes noticeable at 2-4 days after birth. Symptoms are the same as with the classic. The difference is that with the start of treatment, the condition abruptly normalizes, and the symptoms disappear,
  • erased - appears later, 5-7 days after birth. It is characterized by a wave-like manifestation of symptoms: after a sharp jump in poor condition, there is some calm and normalization of well-being. Then again there is a sharp deterioration in all indicators. This form is not characterized by fever, no chills, the woman’s condition is normal,
  • endometritis after cesarean section - acquires a more complex form than after simple birth. Symptoms include bloating, poor stools, and gas. In addition, the amount of urine excreted per day is reduced.

The manifestation of all marked forms have common features and differences.

Causes leading to inflammation

An emergency decision on the operation leads to the fact that the likelihood of inflammation of the mucous membrane increases significantly. Arising from such an operation, it proceeds in a rather severe form. In addition, the inflammatory process develops with great speed and rapidly goes beyond the uterine lining. Inflammation of the endometrium also leads to the occurrence of pathologies such as lymphodenitis, myometritis, and metrotromboflebit.

Infection in the pelvis penetrates due to the suture material, which was imposed after the operation. The uterine contraction process is also impaired.

This complication occurs due to the fact that microorganisms penetrate into the uterine cavity. The interior of the uterus after delivery is one large wound. Its full healing occurs only 5-6 weeks after the joyful event. Microbes stick to the wound after separation of the placenta. Infection penetrates the uterus in two ways:

  • through the vagina,
  • from places where chronic infection was located.

Microbes of pathogenic nature can live in the vagina of many women for quite a long time. With strong immunity, it does not cause them any harm and inconvenience. But after a violation of their calm state, inflammation develops with particular force. Streptococci and staphylococci are most active.

Hard labor in this case is the springboard to such inflammation. In addition to this reason, the onset of postpartum endometritis can lead to:

  • long childbirth, premature withdrawal of amniotic fluid, the fetus for a long time without water,
  • childbirth in women who have a narrow pelvis
  • age of the woman in labor less than 19 years,
  • different forms of placenta previa
  • placental abruption before its time
  • severe blood loss during childbirth,
  • reduced immunity after childbirth and cesarean section,
  • rejection of breastfeeding (as a result, the hormone responsible for the contractile activity of the uterus is not produced in sufficient quantities),
  • infection of the uterus during childbirth.

If a woman is predisposed to the occurrence of this disease, she after childbirth necessarily goes to an ultrasound.

How to identify

Since the postpartum endometritis has hidden symptoms, doctors then monitor the general condition of the woman and, if necessary, prescribe diagnostic examinations. The following procedures are commonly used:

  • analysis of patient complaints,
  • obstetric history analysis,
  • examination of the woman, pulpation of the uterus, examination of the uterus in the mirrors,
  • bimanual vaginal examination - one hand is placed on the woman’s abdomen, the other is inserted into the vagina and the size of the uterus, its soreness, mobility are determined by touch,
  • echographic study
  • ultrasound - the size of the uterus, the structure and volume of its cavity and walls are evaluated. You can also detect the remains of the placenta and blood clot in the cavity,
  • Hysteroscopy is a procedure in which an optical device is inserted into the cavity of the uterus. It is used to inspect the walls of the body and identify the inflammatory process,
  • smear microscopy - the study of the material in the laboratory to determine the infectious agent,
  • biochemical and clinical blood tests.

Only correct diagnosis can lead to proper treatment.

Mild form treatment

Treatment depends on the form in which pathology has arisen and proceeds. Treatment of acute endometritis involves the following activities:

  • antibiotics are prescribed for 5-10 days,
  • anti-inflammatory drugs are prescribed,
  • mechanical cleaning of the uterus is carried out by scraping. It is prescribed if there are remains of the placenta (children's place) or blood clots, as well as a large number of lochia in the uterus,
  • назначаются обезболивающие препараты,
  • прием витаминов,
  • infusion therapy is carried out - a treatment in which saline solutions are administered intravenously. This is necessary to increase the pressure and normalize the salt process in the body,
  • procedures for the purification of blood from harmful substances,
  • physiotherapy.

The latter implies an effect on the inflamed organ with the help of physical factors:

  • electrophoresis - the impact on the diseased organ with direct current and the delivery of drugs to this organ with the help of current,
  • electrotherapy - action on the inflamed area of ​​low frequency currents,
  • Ultrasound therapy - actions similar to massage are performed using ultrasound waves.

This treatment is not basic, but it effectively complements the other therapy.

Treatment of complex chronic forms

If the postpartum endometritis smoothly becomes chronic, treatment follows the following scheme:

  • treating pathologies that are sexually transmitted,
  • hormonal background of the woman is normalized,
  • cleaning the uterus from synechiae.

Antibacterial drugs are selected depending on the origin of the infection that entered the body. If inflammation is caused by a virus, antiviral drugs are prescribed. Acceptance of hormonal drugs involves the administration of oral contraceptives. Reception duration - 3-6 months.

If adhesions are detected during the examination, surgical intervention is applied to correct the situation.

After the start of treatment, body temperature returns to normal. This happens for 2-4 days. Pains go to 5-7 days. Normalization of blood occurs by 6-9 days.

Preventive measures

It is possible to avoid postpartum pathology if you prepare for delivery a little in advance:

  • before pregnancy, it is necessary to undergo examinations to identify various diseases, as well as to cure them,
  • before 12 weeks of pregnancy, you need to register with a gynecologist,
  • visit the doctor regularly during pregnancy

You need to listen to your gynecologist and follow all his recommendations in a timely manner - the disease will bypass.

Methods of treatment of endometritis after cesarean

Endometritis is a very dangerous complication. If the inflammatory process progresses, then soon it will further worsen the condition of the puerperal. That is why the treatment is carried out only in a hospital setting. Endometritis after cesarean can occur in different forms, depending on what is determined by the approach to therapy. In general, treatment is based on the medical, physiotherapeutic and surgical approach.

Drug treatment approach

Drug treatment involves the use of medicines of various groups such as antibiotics and painkillers, anti-inflammatory and detoxification drugs, hormones, etc. Identification of the pathogen is considered to be fundamental, because the etiotropic treatment of pathology is based on this. That is, therapy, the purpose of which is to destroy the causative agent of endometritis.

To improve the contractile activity of the uterus, patients are prescribed No-Shpu and Oxytocin. As a result, the outflow of secretions from the uterine body is improved, and the area of ​​the wound surface is reduced. Immunocorrective agents like Viferon or Kipferon, human immunoglobulin, etc. are also prescribed.

Antibiotic therapy

The basis of treatment of inflammatory lesions of the endometrium is antibiotic therapy. Usually women are prescribed several preparations of broad-spectrum action. This approach provides greater coverage of possible pathogens of pathology, so the chances of a cure are maximized. But if the pathogen is pre-determined, then an antibiotic that is active against a specific microorganism is assigned.

Usually during the treatment of endometritis antibiotic drugs are prescribed like:

  • Ampicillin,
  • Gentamicin,
  • Doxycycline,
  • Ceftriaxone,
  • Cefazolin,
  • Levofloxacin,
  • Clindamycin,
  • Metronidazole, etc.

Sometimes combinations of several drugs are prescribed, for example, metronidazole with the latest generation cephalosporins or aminoglycosides with lincosamides. Preferably the drugs are taken by intramuscular injection.

Anti-inflammatory and painkillers

To inhibit the inflammatory process, nonsteroidal anti-inflammatory groups like Ibuprofen, Diclofenac or Meloxicam, etc., are prescribed. Such drugs block the enzymatic activity, eliminating the enzyme that produces prostaglandins that cause inflammation and painful symptoms. As a result, in addition to the anti-inflammatory effect, NSAIDs also provide an analgesic effect.

The relief of the inflammatory process eliminates the clinical manifestations of endometritis and reduces damage to the uterine mucous layer. But you need to take such funds only by medical recommendation, otherwise the patient’s immunity may be violated.

Endometritis physiotherapy after cesarean

With a protracted and difficult to eliminate inflammation, physiotherapy is indicated. But it is used only in the absence of exacerbation. Endometritis typically uses such physiotherapeutic methods such as UHF-therapy, amplipulse therapy, or electrophoresis with drugs.

Surgical treatment

If the course of endometritis is complicated by the presence of blood clots or placental residues in the uterine cavity, then surgical intervention is suggested, which involves carrying out vacuum aspiration or curettage. If the uterine lesion reaches an irreversible stage, then an operation is performed to remove the uterus.

What is dangerous endometritis after cesarean

At the first manifestations of inflammation, it is necessary to proceed to appropriate treatment, otherwise the development of severe consequences, which manifest themselves in the form of:

  • Peritonitis - when an inflammatory process develops in the tissues lining the peritoneum,
  • Abscesses of the pelvic region - purulent foci are formed, localized in the pelvic area,
  • Pelvioperitonitis or an inflammatory lesion of the serous abdominal membrane that lines the low-fat area,
  • Thrombophlebitis when pelvic veins become inflamed,
  • Sepsis

To avoid such complications, it is recommended to be more attentive to the state after cesarean section and to follow some preventive measures.

Postpartum preventive measures

To prevent the development of inflammatory processes on the mucous membranes, it is recommended to follow the preventive principles. Even before the onset of pregnancy, it is necessary to carefully prepare the body for such a responsible business as carrying and having a baby. It is necessary to plan a pregnancy, even before e onset, eliminating the existing pathologies of a chronic and gynecological nature. Throughout pregnancy, a woman should regularly visit a gynecologist, eat properly and engage in special physical training for pregnant women.

After delivery, it is necessary to prescribe antibiotic therapy if the patient is at risk for the development of endometritis. Also, the woman is recommended to breastfeed the baby, because this process causes the release of oxytocin, which increases the contractile activity of the uterus.

After the operation, you need to lead an active life, sleep more on your stomach, actively move and be sure to comply with hygiene requirements. With timely detection of the inflammatory process endometritis can quickly and safely eliminate. The main thing is to start treatment in time, not allowing the endometrial layer to become chronic.

Causes of pathology

Endometritis after childbirth in women can develop for various reasons:

  1. The inflammatory process after the penetration of microbes during delivery of the existing chronic foci. Gardnerella and Enterobacteriaceae are considered the main pathogens. Their intensive growth is observed in the fall of immunity, in the postoperative and postnatal periods, with intensive blood loss.
  2. Surgical intervention With a higher frequency, endometritis development is observed after delivery by cesarean section. As a result of manipulation, primary infection of the incision site is possible, while the contractile ability of the uterus is reduced, its self-purification is difficult, which creates optimal conditions for the development of pathogenic microflora.
  3. The sharp decline in immune forces. May be observed in the last weeks of the third trimester and immediately after delivery. This increases the risk of possible inflammation. Immunity returns to normal no earlier than 7 days after delivery and up to 10 days after cesarean section.
  4. Chronic unsaved infectious foci. As well as inflammatory diseases, pathologies of the endocrine system, metabolic disorders, existing inflammation of the endometrium during long-term wearing of the IUD, after frequent scraping and abortions, can become a trigger for endometritis.
  5. Complications of pregnancy, exacerbation of chronic pathologies, the threat of miscarriage, polyhydramnios, neck closure, past infection, the use of invasive diagnostic methods.
  6. Complications of childbirth - a protracted process, injury, manual separation of the afterbirth and placenta, blood loss, anhydrous period.
  7. Postpartum complications - unexpressed involution of the uterus, trauma, the development of inflammatory processes, prolonged bed rest, failure to follow the rules of hygiene.
  8. Early onset of sexual activity.

Signs of endometritis can appear as early as 1-2 days after delivery, but more often they develop after 4-10 days. It is also possible that they occur at any time during a few more months.

Symptoms of the disease

After birth, the following symptoms of endometritis may occur:

  1. The manifestation of a mild form - a slight increase in body temperature, non-intense pulling pain in the lower abdomen. Typically, these signs are observed on the 6-10th day, the woman feels chills, tachycardia is diagnosed. Discharge from the uterus is usually standard for the postpartum period.
  2. Severe pathology develops almost immediately, on days 2–3, the temperature rises to 40 degrees, the pulse quickens to 100–120 beats, sharp pain and weakness are present, sleep and appetite are disturbed, the uterus increases and becomes painful. On the fourth day, the discharge acquires a brown tint, then purulent.

Less common pathology in erased form. At the same time, the temperature indices do not exceed 38 degrees, the intensity of uterine contraction decreases, the discharge becomes succinic with a foul-smelling rotten smell.

Treatment of chronic endometritis

In the absence of therapy in the acute stage of the disease and the appointment of inappropriate drugs, the pathology may become chronic. As a result, the risks of miscarriage, unsuccessful IVF, complications in the postpartum period and during pregnancy increase.

The chronic phase of endometritis always tends to increase with the use of intrauterine contraception, with frequent abortions and diagnostic curettage.

In this phase of the disease for the diagnosis used immunocytochemical study. During the inspection, thickening of the shell, serous plaque, adhesions, hemorrhages can be seen.

In the treatment of chronic endometritis phase therapy is carried out. The basis is also antibacterial agents, mainly of a wide range of effects. Combine hormonal and metabolic therapy - taking Utrozhestana, Actovegin, vitamins, Riboxin, Wobenzym.

Directly into the vagina are introduced medical suppositories that prevent uterine bleeding, relieve inflammation.

The second place in the treatment of the chronic phase of the disease takes physiotherapy: electrophoresis using iodine, zinc, copper, lidz, ultrasound and magnetic therapy. Such methods can reduce the inflammatory swelling of the mucous membranes, increase immunity, stimulate blood circulation. Also used balneotherapy.

Auxiliary methods of therapy

Comprehensive treatment of postpartum pathology also includes:

  • personal hygiene,
  • temporary abstinence from sexual intimacy
  • diet therapy with the exception of products that cause stagnation of body fluids,
  • the use of hirudotherapy.

Therapy with vitamin complexes can improve immunity. With the same purpose can be assigned immunostimulants in the form of tablets, suppositories, solutions for intravenous administration.

Anti-inflammatory drugs are used as symptomatic agents, as well as drugs that are aimed at removing toxins from the body, sedative medications.

High performance shows ozone therapy, which strengthens the immune defense and structures metabolic processes. Also used, especially in the acute phase, are oxytocin-based products that increase the contractility of the uterus. When detecting residues of the placenta in the cavity, the uterus is often reorganized with antiseptics.

Possible complications

Manifestations of endometritis not only cause discomfort to the woman, but can also cause serious complications:

  1. Sepsis, that is, blood poisoning. It is the most dangerous postpartum complication. Infection in the course of the movement of lymph and blood spreads to the entire body and may even be fatal.
  2. Risk of purulent-septic pathologies (increased after CS). The frequency of such cases reaches up to 10% among those who have given birth naturally and up to 50% after CS.
  3. The transition pathology in the chronic phase of the course. This threatens future problems with childbirth, leads to pathologies of childbirth and pregnancy.
  4. The risk of developing pelvioperitonitis - accumulations of pus in the pelvic cavity.
  5. Inflammation of the tubes, ovaries.
  6. Regular failure, heavy discharge up to bleeding, disorders of the reproductive system.

To prevent the occurrence of pathology and further complications, one should not underestimate the symptoms, even if erased. Any change in the nature of postpartum vaginal discharge, the appearance of blood, pus, an increase in volume against the background of increasing temperature and pain in the uterus should be the reason for testing and prescription of subsequent treatment by a doctor.

In the past, endometritis that occurs after childbirth was called puerperal fever. According to various sources, this pathology claimed the lives of up to half of all pregnant women. Today, during the widespread use of antibacterial agents, the disease is successfully cured in most cases (with timely initiation of therapy) and does not cause serious consequences.

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