endomyometritis - total septic inflammation of the uterine wall with the involvement of its internal mucous and muscular layers.Like any infectious inflammatory process endomyometritis has several clinical forms and stages of development.The disease always begins acutely, after three or four days after the infectious aggression.The basis of inflammation are pathogens penetrated into the uterine cavity after abortion or childbirth.
Chronic endomyometritis almost always is the result of improper treatment (or lack thereof) of acute inflammation.
uterine wall are three layers: serous, muscular and mucous membranes.Each of them plays an important role and has a close relationship with the others.Serous (perimeter) mother layer covers the outside of the body and protects from external negative influences.The median muscle (myometrium) layer is formed strong muscle and elastic fibers that allow the uterus bear fruit, and pop it in the process of childbirth.The inner mucosa (endo
endomyometritis developing by stages.First infection enters into the uterine cavity, and if it there is a mechanical defect that penetrates the endometrium.Initially, the inflammation is isolated and limited to the mucous layer (endometritis).Inflammation in the next step to be extended to the muscle layer.
very important to understand that the development of endomyometritis possible only when there is a defect of the mucous membrane of uterine cavity.But even if there is a defect in women with a good chance of developing immunity endomyometritis negligible.That is why endomyometritis among other inflammatory gynecological diseases uncommon (0.9%).
Symptoms endomyometritis in any clinical form presented pain, menstrual dysfunction and abnormal vaginal discharge.The most difficult runs in the background endomyometritis postnatal physiological decrease in immunity.
endomyometritis diagnosis is not difficult.After the conversation with the patient to establish close links with the previous occurrence of the disease childbirth, abortion or intrauterine complex manipulations.Laboratory diagnosis clarifies the nature of the infection, and instrumental techniques help determine the condition of the uterine wall, and the extent of inflammation.
endomyometritis therapy involves the use of antibiotics.
At the root of endomyometritis is the only credible reason - infection.And the only condition for its development is the presence of wound surface epithelium lining the uterine cavity.
penetration into the uterine cavity infection can occur in different ways.In 80-90% of cases the source of inflammation are their own opportunistic pathogens colonizing the vagina.They are able to climb the cervical canal into the uterine cavity in the presence of precipitating factors.
Downward infection when it gets into the uterus of the other organs through the blood vessels, it is possible, but it happens very rarely.
nonspecific origin endomyometritis associated with microbial associations, as part of which often remains coccal microflora (streptococci and staphylococci), E. coli and other inhabitants of the vagina.Specific inflammation in the uterus associated with agents of genital infections (trichomonas, gonorrhea, viruses).
endometrium is able to resist the aggression of infectious and is relatively easy to destroy undesirable microorganisms.And only under certain conditions, it can not cope with this task.These are:
- Scraping the entire uterus with medical-diagnostic purposes or during abortion.
- Intrauterine manipulation, leading to the appearance of the wounds on the mucous (aspiration biopsy, hysteroscopy, sensing and the like).
Sharp postnatal endomyometritis also linked to mechanical damage of the endometrium.After removal of the placenta on the inner wall of the uterus is wound surface.
- Genital infections.The specific microflora due to the extreme aggressiveness is able to climb into the uterus and provoke an inflammatory response.
It is recalled that these factors are not always able to hurt the uterus.This reduction is possible only with the immune defense.Otherwise, the organism itself is able to eliminate the likelihood of a negative scenario.
Symptoms and signs endomyometritis
Initially infection entering the uterus, is the most vulnerable portion of the mucosa, penetrates it and provokes local changes.The mucosa swells, loosened and damaged glandular structures responding to infection increased secretion (abundant pus).
If the uterus formed an extensive defect wound, inflammation becomes prevalent, always begins acutely, with severe pain, fever and abundant purulent belyami.
Isolated inflammation of the endometrium there for long, soon the infection deeper into the underlying muscle layer, which greatly impairs the patient's condition.Regardless of the causes of acute endomyometritis always accompanied by sharp pains radiating into adjacent organs and lower back;seropurulent belyami;fever of varying severity.
acute phase of inflammation usually does not last more than ten days.The infection then "leaves" in the thickness of the uterine wall, the symptoms subside, creating the false impression of "recovery" and actually develop a chronic endomyometritis sluggish.
During the conversation, the patient can clearly indicate the time of provoking the disease.Typically, acute endomyometritis case no later than the fourth day after abortion or childbirth.
pelvic examination reveals the sharp pain of the uterus and a large number of abnormal secretions in the vagina.
identify the source of infection and to determine the vector of therapy helps the laboratory and bacteriological examination (smear "flora", bakposev PCR).
Ultrasound scan allows us to consider the nature of the inflammatory changes directly into the uterus and fallopian wall, to determine the depth of infection and the involvement of the inflammatory process in appendages.
Early diagnosis of acute endomyometritis is one of the most favorable scenarios, since the early stages of the disease may be treated without hospitalization of the patient, but provided constant supervision.Therapy is limited to antibiotics, antipyretic and symptomatic means.
Unfortunately, the onset of the disease often occurs erased, so the majority of cases have to be treated endomyometritis stage expressed the spread of infectious inflammation after emergency hospitalization of the patient.
Not always women pay due attention to the first signs of inflammation.Often they seek to cope with the first symptoms themselves, and a doctor of their cause negative effects of chronic endomyometritis, formed in the absence of proper treatment.
Volume therapeutic measures depend on the circumstances that triggered the inflammation.Endomyometritis any origin requires immediate antibiotic.Generally, for maximum effect, use a combination of antibiotics belonging to different groups to work on all the disease-causing microbes.Treatment endomyometritis may take up to ten days.
First, antibiotics are administered intravenously, and then, with the improvement of the clinical situation, a transition only intramuscular injection or tablets.Most others use a combination of intravenous cephalosporin C Metragilom and gentamicin administered intramuscularly.
Antibacterial scheme is made individually, based on the recommendations of the bacteriological laboratory.
endomyometritis Symptomatic treatment involves the use of antispasmodics, vitamins, immune modulators that reduce the uterus means.
Chronic endomyometritis difficult to treat.Infection "out" from the surface of the mucosa into the underlying layers, so antibiotics are administered intramucosal.
endomyometritis lead to serious complications: the formation of a chronic process of inflammation connection tubes and ovaries, a common "blood poisoning".By delayed effects include menstrual dysfunction, the formation of adhesions and infertility.
consequences of chronic endomyometritis very difficult to eliminate.