Endometritis

Excerpt

Endometritis is inflammation localized to the endometrium, the inner uterine lining, commonly due to an infectious etiology. Infection that extends to the fallopian tubes, ovaries, or pelvic peritoneum is termed pelvic inflammatory disease (PID). Endometritis is traditionally classified into 2 types: acute and chronic. Postpartum endometritis is a subtype of acute endometritis associated with pregnancy.

Acute endometritis unrelated to pregnancy refers to an endometrial infection present for ≤30 days. It is typically due to a sexually transmitted infection (STI) or bacterial vaginosis (BV). Common symptoms are similar to those of PID (eg, fever, pelvic pain, vaginal discharge) and can range from mild to severe. Because of the overlapping symptoms, some clinicians consider acute endometritis to be synonymous with PID. Histologically, it is characterized by the formation of microabscesses and neutrophilic invasion into the endometrium. Additionally, although acute salpingitis, which frequently accompanies acute endometritis in PID, is associated with tubal factor infertility due to scarring, acute endometritis alone is not associated with reduced fertility rates.

Chronic endometritis is mild inflammation of the endometrium, typically due to microbial colonization not associated with pregnancy that lasts ≥30 days. It is characterized by plasma cells in the endometrial stroma and other signs of chronic inflammation. Patients are often asymptomatic; however, the most common presenting symptoms are abnormal uterine bleeding, dyspareunia, and pelvic pain. Chronic endometritis is also frequently cited as contributing to recurrent pregnancy loss and infertility. The condition can be difficult to diagnose because, unlike acute endometritis, no defined diagnostic parameters other than endometrial stromal plasmacytes are considered sensitive histologic findings in most studies.

Postpartum endometritis is the most common cause of postpartum infection. Most cases of postpartum endometritis are polymicrobial, involving aerobic and anaerobic bacteria, and are due to the translocation of normal vaginal flora into the uterine cavity during labor and delivery. Endometritis is 5 to 20 times more common in patients undergoing cesarean delivery than vaginal delivery.