Metroendometritis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Metroendometritis occurs if there is inflammation involving two layers of the uterus, the endometrial layer (internal lining of the uterus) and the myometrium (uterine muscle layer).

What Causes Metroendometritis?

The leading cause of metroendometritis is the uterus infection caused by damage to the endometrial layer (internal lining of the uterus) that generally occurs in women with less immunity. In most cases, the infection reaches the uterine cavity through the vagina. About 80 % to 90 % of the disease is not caused from outside but by the normal vaginal microflora. When microorganisms find a tear or damage in the tissue lining the uterus, they multiply and slowly penetrate the deeper layers. Streptococci, staphylococci, viruses, e.coli, and other microorganisms cause metroendometritis.

Below are the causes of endometrial infections:

• During the abortion, there will be complete removal of the inner layer of the uterus. Therefore, after removing the inner layer, there will be sizable unprotected wound surfaces with damaged blood vessels. Any blood remaining in the uterine cavity can also cause infection because it acts as a medium for infection. The infections can quickly get into the inner muscle layer called the myometrium.

• Injuries in the uterus are caused during diagnostic procedures like hysteroscopy, aspiration biopsy, and sensing.

• Through the filaments of the intrauterine device, the microorganism enters the uterine cavity.

• Improper intrauterine procedures.

• Sex infections, specific microflora spread rapidly from the vagina affecting the surrounding structures.

• When there are changes in normal vaginal biocenosis (different organisms forming a closely integrated community) the protective properties of the vaginal lining are reduced, which causes the infections to pass to the uterus easily.

Postnatal metroendometritis occurs due to

• Decreased immunity after a complicated delivery.

• Blood accumulation in the uterine cavity.

• Wound in the site of separation of the placenta.

• If there is any damage to the contractile property of the uterus, the uterus cannot come back to its original shape and remains loose and has a high chance of infections.

What Are the Types of Metroendometritis?

There are two types of Metroendometritis, acute and chronic.

Acute Metroendometritis - It occurs after childbirth, abortion, or medical and diagnostic procedures in the uterine cavity. The infection penetrates the endometrium (internal lining of the uterus). The disease causes fever, purulent or serous-purulent discharge, and severe pain. During the examination, purulent discharge from the cervical canal can be seen, and probing the uterus causes discomfort and may be slightly enlarged and softened.

Chronic Metroendometritis - It does not show any prominent signs making the diagnosis difficult. In the early chronic stage, there may be prolonged menstruation, and in advanced stages, there will be a slight increase in temperature, moderate pelvic pains, and persistent serous-purulent discharge.

What Are the Signs and Symptoms of Metroendometritis?

The symptoms of metroendometritis differ depending on the type of infection, immunity status of the patient, and the form of the disease. These are the common symptoms seen in patients with metroendometritis.

• Pelvic Pain - in the initial stage, if the infection affects only the endometrium, the pain is mild. It does not affect the patient’s well-being. Suppose the patient does not take proper treatment in this stage, the disease-causing organism multiplies and penetrates the deep layers of the myometrium, causing severe pain in the abdominal region and lower back.

• Pus or Serous Discharge - Gonococcal infection causes abundant purulent discharge, irritating the vulva (female reproductive organ) and urethral tissues. Impure blood appears in the discharge if the condition is left untreated. An unpleasant odor also occurs when E. coli or trichomonads are present.

• During the examination, probing of the uterus causes severe pain.

How Is Metroendometritis Diagnosed?

The following tests diagnose Metroendometritis:

• Blood Test - An increase in leukocytes and ESR rate in the blood report, indicating the presence of inflammation.

• Vaginal and Cervix Smear - Smear tests of the vagina and cervix suggest the microbial composition and the severity of the inflammation.

• Bacteriological Study - This study helps to identify the pathogen and suggest the ideal antibiotics.

• Transvaginal Ultrasound Scan - It detects abnormalities in the pelvic area and uterus. It also helps to check for any blood clots and remains of afterbirth in the uterine cavity.

• Laparoscopy - When there are difficulties in diagnosing metroendometritis, a laparoscopy test is suggested.

What Is the Treatment for Metroendometritis?

Acute Metroendometritis – In acute cases, hospitalization is necessary to prevent the transition from acute to chronic stage and further spread of infection.

• A good diet should be followed for the normal functioning of the digestive tract.

• Cold application in the lower abdomen to avoid bleeding and reduce pain.

• Suppose the disease develops after a fragment of the afterbirth or a delaying part of the fetal egg. In that case, the foreign parts should be cleaned from the uterine cavity to prevent them from contracting and causing bleeding. The uterine cavity should be scrapped under the cover of antibiotics.

• Antibiotic therapy is given according to the condition of the patient and the cause of the disease. They can be injected intravenously into the muscle or taken in tablet form.

• Parallel use of Antifungal drugs because intensive use of large doses of antibacterial medications can cause dysbiosis (reducing microbial diversity and loss of beneficial bacteria).

Chronic Metroendometritis - In chronic inflammation, the location of the infection is identified inside the mucous layer, so administering antibiotics to the location is effective.

• Vaginal ointments, suppositories, or irrigation solutions are used to eliminate local inflammation and prevent dysbiosis in the vagina.

• Symptomatic treatment includes uterine contractions, vitamins, and immunomodulators.

• Laparoscopy is used to dissect any adhesion accompanied by chronic metroendometritis

Conclusion:

Metroendometritis is an infectious inflammation of the uterus's endometrium and myometrium layer. It usually occurs when the infection penetrates deep inside the uterus and is most commonly seen in immunosuppressed patients. The symptoms are mild and often left unnoticed. Antibiotic treatment is recommended to reduce and eliminate infections. Consult a healthcare provider at the earliest if you experience any of the symptoms of metroendometritis.