Endometritis: symptoms and treatment, diagnosis - acute, chronic, postpartum. Treatment of endometritis in women - pregnancy and IVF with endometrium
In the structure of gynecological pathologies in womenOf childbearing age, the frequency of endometritis varies from 3% to 70%, which is associated with a large variability in the number of observations, the complexity of the morphological verification (confirmation) of the diagnosis, the differences in the contingent of patients and the material analyzed. Despite the expansion of the pharmacological base, endometritis, the symptoms and treatment of which may differ significantly depending on the clinical manifestations, practicing physicians experience certain difficulties with the diagnosis and therapy of the disease. This is explained by the features of endometritis in modern conditions: increased resistance of pathogenic microflora to drugs, a mutation of the etiologic structure of the disease with an increase in the viral flora, and long periods of treatment.
What is endometritis in women?
Endometritis is a clinical and morphological syndrome,Which is characterized by a complex of changes in the endometrium of inflammatory origin, provoking a violation of the "receiving" ability and cyclic transformation of tissue. The disease leads to a decrease in the fertility of women, malfunction of menstrual function, miscarriages, fetal development anomalies, infertility. At the same time, the effectiveness of endometrial therapy does not exceed 60-68%.
Acute endometritis: symptoms and treatment
Arisen primary inflammatory process, notLeaving beyond the uterus, develops as a result of the ascent of the infectious agent along the cervical canal. Most often, bacteria penetrate the endometrium with damage to the integrity of the cervical barrier - during abortion, scraping of the uterus body and mucous neck, intrauterine device spiral and other interventions.
Signs of acute endometritis:
- A sharp increase in temperature;
- Chills, pain in the lower abdomen;
- The appearance of a purulent separable from the genital tract.
- Collection of anamnesis (absence / presence of intrauterine intervention, necrosis of mucous node);
- Gynecological examination (reveals an enlarged uterus);
- Bacteriological research (defines strains of microbial flora);
- Ultrasound of the pelvic organs;
- Laparoscopy (makes it possible to examine the appendages, exclude other surgical pathologies);
- Endometrial biopsy.
Treatment and prognosis
Acute endometritis necessarily requires admissionAntibiotics. The inflammatory process affects the basal layer of the endometrium due to infection with nonspecific / specific pathogens. Protective resources of the endometrium are directly related to the effect of sex hormones, "work" in conjunction with a population of cells that neutralize harmful particles. With the onset of menstruation, this barrier disappears, which makes infection of the mucous membrane possible. The treatment scheme includes antibiotic therapy and physiotherapy. The prognosis is favorable: with adequate and timely treatment, after 7-10 days, a full recovery comes.
Chronic endometritis: symptoms and treatment
Chronic endometritis is a disease in whichDue to prolonged infectious lesions of the endometrium, secondary functional changes occur that disrupt the receptor status and cyclical transformation of the uterine body. In 95% of cases, ChE is an exogenous, provoked by microorganisms, sexually transmitted, and arising after intrauterine manipulation. In 5% of cases, ChE develops as a result of infection by a lymphogenic, hematogenic, descending method from extragenital foci. Isolate nonspecific and specific, caused by mycoplasmas, fungi, bacteria, viruses, chronic endometritis.
Endometrite of the uterus - predisposing factors:
- Decreased immunological defense of the body;
- Unsatisfactory living conditions, bad habits, malnutrition;
- Infectious-inflammatory diseases;
- neuroendocrine pathologies, arterial hypertension;
- inflammatory kidney disease;
- autoimmune failures, STDs, anemia, bronchopulmonary diseases;
- diseases of the female reproductive system;
- long-term use of intrauterine spirals, transferred to cesarean section;
- a large number of instrumental interventions in the uterine cavity;
- complications after childbirth / pregnancies of an infectious-inflammatory nature;
- infections of the cervix / vagina;
- Radiation therapy in the pelvic area.
Symptoms of chronic endometritis:
- violation of menstrual function. The presence of a persistent inflammatory focus in the small pelvis provokes a malfunction of the menstrual cycle in 50-60% of patients - this is manifested by amenorrhea, algodismenorei, oligomenorrhea. The most common complaints are intermenstrual and contact spotting, profuse monthly, persistent pelvic pains;
- abdominal pain, abnormal uterine bleeding;
- disruption of the functioning of the gastrointestinal tract. Discomfort during bowel movement, constipation, bloating, flatulence, decreased appetite;
- influenza-like conditions. The fever, fever, body aches, general malaise.
Chronic endometritis: symptoms and treatment, diagnosis
Diagnosis of chronic endometritis is based on the analysis of the history, clinical symptoms, morphological study of the endometrium, which is performed on the 7-10th day of the cycle.
Criteria for the morphological diagnosis of chronic endometritis:
- Inflammatory infiltrates, which consist oflymphoid components located around the blood vessels and glands, less often - diffusely. In appearance, the foci resemble follicles and are localized in all segments of the functional layer;
- presence of plasma cell material;
- a limited focus of the stroma, formed with a long course of the inflammatory process, in some cases, exciting large areas;
- sclerotic deformations of the walls of the spiral arteries of the tissue that appear against the background of severe symptoms and persistent prolonged flow of the endometritis.
The gold standard in the treatment of HE is a stepwise approach,aimed at eliminating the causes of inflammation and eliminating the effects of the inflammatory process, including the elimination of tissue ischemia, secondary damage, regeneration of the receptor apparatus and local hemodynamics of the endometrium. The complex scheme should be pathogenically and etiologically justified and be based on the results of a thorough examination.
Stages of therapy CHE:
- Elimination of the damaging agent or reductionvirus activity. Antimicrobial treatment should ensure the removal of a wide range of pathogenic organisms, including trichomonads, chlamydia, streptococci, gonococci, and viruses. In some cases, doctors prescribe several courses with the change of medicinal groups, the choice of which depends on the results of microbiological examination of the uterine cavity and vagina, the stage of the inflammatory process and the features of the clinical picture. In parallel, correction of immune failures is carried out.
Preparations: combination of nitroimidazoles (Metronidazole, Ornidazole) and fluoroquinolones (Ciprofloxacin, Ofloxacin, Levofloxacin), combination of protected penicillins with macrolides (Spiramycin, Roxithromycin). If a viral infection is present, nucleoside analogues are used (Valtrex, Acyclovir).
Gegeneration of the morphofunctional potentialendometrium and the elimination of the consequences of pathological damage: the restoration of metabolism, activity and hemodynamics of tissue receptors. Patients with a clear violation of reproductive function are additionally prescribed phase hormone therapy, which is designed to increase the likelihood of implantation.
Preparations: metabolic drugs (Actovegin)
Physiotherapy: magnetotherapy, electropulse therapy.
The main criteria for successful treatment: a significant decrease in the activity of the infectious agent, relief of clinical manifestations of the disease, restoration of echography and morphological structure of tissue, regeneration of fertility.
Candles with ChE
Candles for the treatment of chronic endometritisThey are used as an additional local remedy to achieve the fastest recovery. They prevent vaginal contamination by dangerous microorganisms against the background of taking antibiotics, do not allow the development of serious complications and secondary damage to the uterus by bacterial agents from the lower genitalia.
In what situations are candles used:
- acute endometritis, which is accompanied by vaginal dysbiosis;
- inflammation of the cervix / vagina;
- chronic endometritis;
- adhesions in the uterine cavity / cavity of the small pelvis.
Types of vaginal suppositories:
- combined. Contain: Neomycin (aminoglycoside antibiotic), Ternidazole (antimicrobial drug), Prednisolone (glucocorticoid), Nystatin (antifungal agent);
- with an antiseptic. Candles with betadine (iodine-containing agent) and with chlorhexidine (antiseptic);
- with medicinal plants. Have a soothing, healing, antimicrobial, anti-inflammatory effect.
Vaginal suppositories can not be considered primarymethod of therapy. Assign them to only a specialist, taking into account the stage, clinical picture and overall well-being of the woman. The standard duration of treatment with candles is 12-14 days.
Postpartum endometritis: symptoms and treatment
Postpartum endometritis - inflammation of the mucosathe uterus that occurs after childbirth. In 10-12% of cases the inflammatory process migrates to the muscular layer of the uterus, provoking the development of endomyometritis. PE is diagnosed quite often - it is caused by a number of factors: the widespread use of invasive diagnostic techniques, an increase in the frequency of surgical operations during delivery, the accumulation of antibiotic-resistant strains of microorganisms in hospitals, the use of corticosteroids that are characterized by immunosuppressive action. He underwent strong changes and a contingent of parturient women - today women with various forms of infertility, with extragenital pathologies, after hormonal correction of miscarriages, with a viral infection, who are at higher risk for infectious complications, predominate.
Endometritis after childbirth - symptomatology
On the 5-10th day after childbirth, the temperature risesup to 38-39 degrees, a strong chill begins, the pulse rate increases to 85-100 beats per minute. In the blood, the number of leukocytes and the rate of erythrocyte sedimentation increases, the uterine soreness and spotting are fixed. Severe endometritis "starts" on day 2-3 after delivery. In 25% of cases it develops after cesarean section or complex labor. Weakness, headache, abdominal pain, anorexia, chills, tachycardia, high fever (above 39 degrees) are noted. After 1-2 days, the uterine secretions become purulent. Postpartum endometritis is often complicated by intestinal paresis, which leads to the entry of microbes into the peritoneal cavity and peritonitis.
Treatment of postpartum endometritis
PE therapy should be comprehensive, directedon the localization of the focus of inflammation, neutralization of the infectious agent, activation of the protective mechanisms of the body and detoxification. Inherent elements of treatment are general restorative, antibacterial, infusion (intravenous infusion) therapy, use of drugs that reduce the uterus. Sometimes the surgical treatment of the uterus is shown, severe forms of endometritis require the use of plasmapheresis - the removal of abnormal components of blood plasma, microbes, toxins, cryoglobulins. The effectiveness of therapy is estimated at 7 days, in the absence of a positive result, the question of removing the uterus is solved.
Treatment of endometritis with folk remedies
People's methods of treating endometritis are quite effective, if they are used after consultation with a doctor who will choose the optimal combination of tablets and folk remedies.
Infusion of ivy. Take a tablespoon of crushed ivy leaves, pour 250 milliliters of boiling water, insist 12-14 hours. Bring the infusion to a boil, remove from heat, insist 10-15 minutes, carefully strain. Use three times a day for 100 milliliters. For taste, you can add sugar or honey. Contraindications: individual intolerance, anemia, pregnancy.
Collected herbs. Medicinal plants destroy the infection, restore the integrity of the mucosa, stop the inflammatory process:
- valerian root, yarrow, mint, heather flowers, birch leaves, buckthorn bark, blackberry leaves;
- grass goose geese, valerian root, mint leaves, buckthorn bark;
- grass rue, herb tansy, licorice root, aira.
- Broth of St. John's wort. Take a large spoonful of herbs, pour a glass of boiling water, put on fire, boil for 15-20 minutes, drain. Drink the broth three times a day for 50 milliliters on an empty stomach.
Infusion of fern. Tablespoon leaves of fern (crushed) brew 250 milliliters of boiling water, insist 15-20 minutes, drain. Eat 50-70 milliliters four times a day before meals. The course of treatment is 14-21 days.
Tampons with antibacterial action:
- with garlic. Counteract inflammation and infection. Peel a clove of garlic, cut in 2-3 places, dipped in vegetable oil, wrapped in gauze, put into the vagina for 10-12 hours;
- with sea buckthorn oil. Accelerate mucosal healing;
- with a plantain. Soothe and help the healing of the mucous uterus. Wash the fresh leaves of plantain, grind, mix with oil. Turn the resulting mixture into gauze, put into the vagina for 10-12 hours.
Endometritis and endometriosis: what's the difference?
Despite similar names, endometriosis andendometritis - completely different diseases. By its characteristics, endometriosis resembles malignant neoplasms, has no relation to inflammatory processes of immune etiology in endometrium, differs from them by clinic and laboratory-diagnostic data.
Endometriosis - the formation of benignnodes, similar in structure to the uterine mucosa. Tumors form on the background of hormonal abnormalities, localized in the pelvic region - from the uterus and ovaries to the bladder and intestine. The pathogenesis of the disease is not fully understood, physicians tend to believe that endometriosis is a defect in the immune system. Due to immune disorders, the endometrium is thinned. Endometritis is an inflammatory process of the uterine membrane of an infectious origin, leading to endometrial hyperplasia.
During menstruation with endometriosis, normalthe mucous membrane is rejected, the endometrial cells re-enter the fallopian tubes, settle and begin to divide, "building" a new tissue close in configuration to the endometrium. A node is formed - endometriosis is progressing. The generalization of the pathological process aggravates the situation: the number of nodes grows in a geometric progression, the thickness of the endometrium melts. With endometritis, due to a significant increase in the thickness of the uterine membrane, the cyclicity of the menstrual period is knocked off. The shell is exfoliated and restored in parts, with regular bloody discharge.
Endometritis: the focus of inflammation excludes the possibility of normal implantation of the embryo into the endometrium.
Endometriosis: a weak endometrium loses the ability to implant an embryo into itself and hold it. Scattered around the entire pelvic area, the nodes signal that they are ready to "take" the embryo, which leads to a complete imbalance in the body systems.
Can I get pregnant with an endometrium?
Among patients with an endometritis in a history of 97%are women / girls of reproductive age, which only emphasizes the significance of the disease in terms of its impact on fertility. Is pregnancy possible with endometrium? Theoretically, yes. The sensitivity of the endometrium and reproductive functions are partially preserved at the initial stage of the disease due to the presence of compensatory mechanisms, the effectiveness of which directly depends on the activity of infectious agents, the state of the immune system, and the adequacy of hormonal regulation.
Chronic endometritis and IVF
According to WHO, the frequency of infertile marriages in ourthe country has a clear tendency to increase, which leads to an increase in the number of ongoing assisted reproduction programs. Unfortunately, the percentage of ineffective implantation of embryos is very high - on average it is 50-60%. One of the main reasons for the failure of IVF programs is the pathology of the endometrium, endometritis including. The prolonged and often asymptomatic persistence (finding) of viruses and bacteria in the endometrium provokes severe deformations of the tissue structure, preventing healthy implantation and placentation of the embryos. Violations of cyclic transformation and proliferation (regeneration) of the endometrium reduces the frequency of successful implantations and reduces the effectiveness of IVF as a whole.
Causes of infertility in endometrium:
- damage to the receptor function of the uterus with a malfunction of a healthy perception of hormonal action;
- exceeding the norm level of estradiol, which has a negative effect on the work of the yellow body during the second phase of the cycle;
- deformation of spiral vessels that do not experience pregnancy-specific stress;
- violation of normal blood flow in the uterus;
- development in the uterine cavity of adhesions that disrupt the process of introduction of the oocyte;
- autoimmune destruction of spermatozoa trapped in the uterine cavity;
- cicatricial mutation of the fallopian tubes due to migration of the infection to neighboring organs.
The greatest danger is ChE, sinceit proceeds with a blurred clinical picture. In acute endometritis, a woman is concerned about the clearly expressed symptoms that make her turn to the doctors. In addition, the acute process, in contrast to chronic, responds better to therapy.
The pre-IVF screening program
Patients with a history of the diseasefailure / failure of implantation of embryos, must undergo pregravid preparation (preparation for pregnancy), which includes preventive, diagnostic and therapeutic measures. After pre-gravity preparation, the effectiveness of the first IVF attempt against the background of endometritis is 45-50% on average.
Stages of examination:
- Ultrasound of the uterus / appendages, bacteriological analysis of aspirate from the uterine cavity and separable from the cervix;
- dopplerometric testing of appendages and uterus with determination of blood flow in the pelvic region;
- evaluation of the immune status;
- determination of the level of pituitary hormones, thyroid gland; sex hormones;
- morphological evaluation of biopsy material for the neglect of pathology.
Features of IVF in endometrium
Hormonal support for 3-5 months. Preparations are selected taking into account the data of laboratory tests and the age of the woman. It allows to regenerate the sensitivity of uterine receptors to hormonal effects:
- women with normal thickness of the endometrium (8millimeters and more) and normal blood flow in the basal arteries is prescribed Dydrogesterone inside, 10 mg twice a day. Treatment course - 10 days (from 16 to 25 day cycle);
- Patients with reduced endometrial thickness are prescribed Femiston on a pill once a day (28 days course) or carry out phase therapy with hormones (Estradiol + Dydrogesterone);
- women who have a history of a combination of decreased blood flow in the vessels with a decrease in the thickness of the endometrium, appoint metabolic therapy and a course of acupuncture.
- Confirmed violation of blood flow requires appropriate therapy with anticoagulants, antiplatelet agents and phlebotonic agents.
- In the presence of pathogenic flora in the uterus prescribe antiviral and antibacterial drugs.
- With deviations in the functioning of the immune system, immunomodulatory therapy is performed.
- Assign physiotherapy procedures that stimulate blood flow and increase local immunity.
Endometritis, the symptoms and treatment of which in many respectsdepend on the severity of the clinical picture - a serious and insidious disease, leading to infertility and miscarriage. A late diagnosis, an incorrect treatment regimen can lead to the emergence of generalized forms of infection, so at the first alarm signs should immediately consult a doctor and begin a course of therapy.