2. INTRODUCTION Endometrium is protected from infection due to â
⢠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 itâs 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.