FAQ - Endometritis
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Can anyone tell me what the difference is betwen endometritis and endometriosis?


Ive been having a lot of lower abdominal pain and lower back pain and am having a laparoscopy and hysteroscopy in 2 weeks time. I have been told that endometritis and endometriosis are possibilties but after looking on line they seem to be one and the same???

I'd appreciate anyones advice.

Thank you x
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No, they are not the same. Endometriosis is not an infection, it's a condition where the endometrial cells grow outside of the uterus. Endometritis simply means an infection/inflammation of the endometrium (inner lining of the uterus).  (+ info)

Are there any treatments or cures for endometritis?


My sister, who is 15, was dignoesd with endometritis saturday night. i know what it does but i was wondering if anyone could tell me if there were and treatments or cures for it. ever since she was lil she has wanted kids and now we are trying to find a way to tell her that in the future she wont be able to have them. i know she is only 15 but still. if any one could help it would be very much grateful!
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This is a horrible condition so it's a shame your sister has this. As a fellow sufferer I have been put on BC and told to monitor my diet (not too much sugar or additives that induce extra hormones, apparently) but my ob gyn is quite honest with me - she says that the medical profession aren't really sure why it happens. There appears to be some sort of genetic link - not proven but just from the fact that many families suffer from it. She also says that like any hormonal condition it is helped by reducing hormonal surges, and often pregnancy (not that i'm suggesting this for your sister!)

I've been told not to worry about having kids. My ob gyn recommends trying when I am ready and if there are problems then I can get help as needed. She said she has loads of patients that have conceived naturally with this condition, and also said that after most have had one they never have more problems.

Please wish your sister and family best of luck coping with this.  (+ info)

I was diagnosed with possible postpartum endometritis and have to pump and dump.?


How much breastmilk should my 12 week old receive in a day.
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I have read from 28 to 32 oz. per day.  (+ info)

i had an operation in oct to remove endometritis and cysts. was then given an injection?


to stop everything from working for three months. it has been four months now and no sign of period. whats happening? trying to conceive so getting worried now
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My advise is don't do anything without consulting ur doctor. He/She should start putting u on meds in order to start ovulation and TTC.
You should be monitored monthly too by ultrasound in order not to be over stimulated and form cysts again. This happend to me when I started TTC few years after my lap to remove a cyst. The meds i took to ovulate for about 8 months made my endo worse. So the doc should balance the meds. If you don't get pregnant after few months, the doc should be able to tell if the ovulation meds work or should u seek other ways like IUI or IVF.
For me, after removing my endo and cyst for the 2nd time, my fertility specialist wanted me to try naturally for a month or 2 if i want, but the chances are not so high and suggested IVF. I decided to go for IVF as I tried many months before and it didnt happen. Now I am in the preparation stage and I pray to God it works.
Baby dust to all of us trying to conceive.  (+ info)

what will be the laboratory examination results for endometritis?


found this article hope it helps



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Get CME/CE for article You are in: eMedicine Specialties > Obstetrics and Gynecology > General Obstetrics

Endometritis
Article Last Updated: Aug 15, 2007
AUTHOR AND EDITOR INFORMATIONSection 1 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References

Author: Gema T Simmons, MD, Consulting Staff, Department of Obstetrics and Gynecology, Alegent Health

Gema T Simmons is a member of the following medical societies: American College of Obstetricians and Gynecologists

Editors: Anthony Charles Sciscione, DO, Director, Division of Maternal-Fetal Medicine, Professor, Department of Obstetrics and Gynecology, Drexel University College of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Antonio V Sison, MD, FACOG, Program Director, Department of Obstetrics and Gynecology, Robert Wood Johnson University Hospital; Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital; Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Author and Editor Disclosure

Synonyms and related keywords: metritis, endomyometritis, endomyoparametritis, myometritis, Cesarean delivery, C section, pelvic inflammatory disease, PID, retained products of conception, obstetric endometritis, nonobstetric endometritis, salpingitis, Ureaplasma urealyticum, Peptostreptococcus, Gardnerella vaginalis, Bacteroides bivius, group B Streptococcus, Chlamydia, Enterococcus, cesarean delivery, bacterial vaginosis


INTRODUCTIONSection 2 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


Background
Endometritis is an infection of the endometrium or decidua, with extension into the myometrium and parametrial tissues. Endometritis is divided into obstetric and nonobstetric endometritis. It is the most common cause of fever during the postpartum period. Pelvic inflammatory disease (PID) is a common predecessor in the nonobstetric population.

Pathophysiology
Endometritis is infection of the endometrium or decidua, with extension into the myometrium and parametrial tissues. Endometritis usually results from an ascending infection from the lower genital tract. From a pathologic perspective, endometritis can be classified as acute versus chronic. Acute endometritis is characterized by the presence of neutrophils within the endometrial glands. Chronic endometritis is characterized by the presence of plasma cells and lymphocytes within the endometrial stroma.

In the nonobstetric population, PID and invasive gynecologic procedures are the most common precursors to acute endometritis. In the obstetric population, postpartum infection is the most common predecessor. Chronic endometritis in the obstetric population is usually associated with retained products of conception after delivery or elective abortion. In the nonobstetric population, chronic endometritis has been seen with infections, such as chlamydia, tuberculosis, and bacterial vaginosis, and the presence of an intrauterine device.


Frequency
United States
Incidence varies depending on the route of delivery and the patient population. After a vaginal delivery, incidence is 1-3%. Following cesarean delivery, incidence ranges from 13-90%, depending on the risk factors present and whether perioperative antibiotic prophylaxis had been given.

Mortality/Morbidity

Infection of the genital tract is the most common cause of puerperal morbidity. Puerperal morbidity is defined as a temperature of 100.4°F (38°C) or higher occurring in any 2 of the first 10 days postpartum, exclusive of the first 24 hours. In the past, infection accounted for up to 16% of maternal mortality.
In the nonobstetric population, concomitant endometritis may occur in up to 70-90% of documented cases of salpingitis.

Age
This disorder affects females of reproductive age.




CLINICALSection 3 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


History
Diagnosis usually is based on clinical findings.


Fever
Lower abdominal pain
Foul-smelling lochia in the obstetric population
Abnormal vaginal bleeding
Abnormal vaginal discharge
Dyspareunia (may be present in patients with PID)
Dysuria (may be present in patients with PID)
Malaise

Physical

Fever, usually occurring within 36 hours of delivery, in the obstetric population
Lower abdominal pain
Uterine tenderness
Adnexal tenderness if there is an associated salpingitis
Foul-smelling lochia
Tachycardia

Causes

Endometritis is a polymicrobial disease involving, on average, 2-3 organisms.
In the majority of cases, it arises from an ascending infection from organisms found in the normal indigenous vaginal flora.
Commonly isolated organisms include Ureaplasma urealyticum, Peptostreptococcus, Gardnerella vaginalis, Bacteroides bivius, and group B Streptococcus.
Chlamydia has been associated with late-onset postpartum endometritis.
Enterococcus is identified in up to 25% of women who have received cephalosporin prophylaxis.
Route of delivery is the most important factor in the development of postpartum endometritis.
Major risk factors include cesarean delivery, prolonged rupture of membranes, long labor with multiple vaginal examinations, extremes of patient age, and low socioeconomic status.
Minor contributing factors include maternal anemia, prolonged internal fetal monitoring, prolonged surgery, and general anesthesia.
Bacterial vaginosis has been associated with endometritis after cesarean delivery and with PID after first trimester elective abortion.



DIFFERENTIALSSection 4 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References

Appendicitis
Pelvic Inflammatory Disease

Other Problems to be Considered

Pyelonephritis
Viral syndrome
Pelvic thrombophlebitis



WORKUPSection 5 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


Lab Studies

On complete blood count the finding of leukocytosis may be difficult to interpret, secondary to the physiologic leukocytosis of pregnancy.
Blood culture is positive in 10-30% of cases.
Urine culture should be ordered.
Endocervical cultures (or DNA probe) are obtained for gonorrhea and chlamydia.
Culture of the endometrial cavity usually results in contamination from normal resident cervicovaginal flora.

Imaging Studies

Perform imaging studies on patients who do not respond to adequate antimicrobial therapy in 48-72 hours.
CT scanning of the abdomen and pelvis may be helpful for excluding broad ligament masses, septic pelvic thrombophlebitis, ovarian vein thrombosis, and phlegmon.
Sonographic findings of the abdomen and pelvis may be normal in patients with a clinical diagnosis of endometritis. Abnormal findings overlap with those of retained products of conception and intrauterine hematoma.

Procedures
Endometrial biopsy can be obtained to assess chronic endometritis in the nonobstetric population.




TREATMENTSection 6 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


Medical Care
Most cases of endometritis, including those following cesarean delivery, should be treated in an inpatient setting. For mild cases following vaginal delivery, oral antibiotics in an outpatient setting may be adequate.



Combination intravenous clindamycin and gentamicin administered every 8 hours has been considered the criterion standard treatment. Recent studies have revealed adequate efficacy with daily dosing as well.
Second- or third-generation cephalosporin in combination with metronidazole is another popular choice.
Improvement is usually noted within 48-72 hours in nearly 90% of women. Parenteral therapy is continued until the patient has been afebrile for longer than 24 hours. Thereafter, oral antibiotics are not usually necessary.

Surgical Care
Surgical management is not usually necessary in acute endometritis in the obstetric population. Dilatation and curettage may be advised for retained products of conception, however.




MEDICATIONSection 7 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


After making the diagnosis of endometritis and excluding other sources of infection, broad-spectrum antibiotics should be promptly initiated. Improvement will be noted within 48-72 hours in nearly 90% of women treated with an approved regimen. For mild cases following vaginal delivery, an oral agent may be adequate.


Drug Category: Antibiotics

A combination therapy with clindamycin and an aminoglycoside is considered the criterion standard by which most antibiotic clinical trials are judged.

A combination regimen of ampicillin, gentamicin, and metronidazole provides coverage against most of the organisms that are encountered in serious pelvic infections.

Doxycycline should be used if Chlamydia is the cause of the endometritis.

Ampicillin sulbactam can be used as monotherapy. Single-agent therapies have been found to be efficacious in 80-90% of patients.

Drug Name Clindamycin (Cleocin)
Description Used in combination with gentamicin. Lincosamide useful as a treatment against serious skin and soft tissue infections caused by most staphylococci strains. Also effective against aerobic and anaerobic streptococci, except enterococci.
Inhibits bacterial protein synthesis by inhibiting peptide chain initiation at bacterial ribosome where preferentially binds to the 50S ribosomal subunit, causing bacterial growth inhibition.
Adult Dose 900 mg IV q8h
Pediatric Dose 20-40 mg/kg/d IV divided q6-8h
Contraindications Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis
Interactions Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption
Pregnancy B - Usually safe but benefits must outweigh the risks.

Precautions Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile
American Academy of Pediatrics states that clindamycin is compatible with breastfeeding

Drug Name Gentamicin (Gentacidin, Garamycin)
Description Aminoglycoside antibiotic used for gram-negative bacterial coverage. Used in combination with either clindamycin or in combination with metronidazole and ampicillin.
Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in the volume of distribution. Dose may be given IV or IM.
Adult Dose 1.5 mg/kg IV q8h
Pediatric Dose 2-2.5 mg/kg/d IV q8h
Contraindications Documented hypersensitivity; non-dialysis-dependent renal insufficiency
Interactions Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; aminoglycosides enhance effects of neuromuscular blocking agents, thus prolonged respiratory depression may occur
Coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly)
Pregnancy C - Fetal risk revealed in studies in animals but not established or not studies in humans; may use if benefits outweigh risk to fetus

Precautions Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment; data are lacking concerning use while breastfeeding


Drug Name Ampicillin (Omnipen, Marcillin)
Description Used in combination with gentamicin and metronidazole. Interferes with bacterial cell-wall synthesis during active multiplication, causing bactericidal activity against susceptible organisms.
Adult Dose 2 g IV q6h
Pediatric Dose 50-200 mg/kg/d IV divided qid
Contraindications Documented hypersensitivity
Interactions Probenecid and disulfiram elevate levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Pregnancy B - Usually safe but benefits must outweigh the risks.

Precautions Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction


Drug Name Metronidazole (Flagyl)
Description Used in combination with gentamicin and ampicillin. Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Appears to be absorbed into the cells and the intermediate-metabolized compounds that are formed bind DNA and inhibit protein synthesis, causing cell death.
Adult Dose 500 mg IV q6h
Pediatric Dose 15-30 mg/kg/d IV divided bid/tid
Contraindications Documented hypersensitivity
Interactions May increase toxicity of anticoagulants, lithium, and phenytoin; cimetidine may increase toxicity; disulfiram reaction may occur with orally ingested ethanol
Pregnancy B - Usually safe but benefits must outweigh the risks.

Precautions Adjust dose in hepatic disease; monitor for seizures and development of peripheral neuropathy
American Academy of Pediatrics states that metronidazole should be used with caution while breastfeeding


Drug Name Ampicillin/sulbactam sodium (Unasyn)
Description Has been found to be efficacious as monotherapy in 80-90% of patients. Drug combination that uses a beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.
Adult Dose 3 g IV q6h
Pediatric Dose 1.5-3 g IV q8h
Contraindications Documented hypersensitivity
Interactions Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Pregnancy B - Usually safe but benefits must outweigh the risks.

Precautions Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction; compatible with breastfeeding


Drug Name Doxycycline (Bio-Tab, Doryx, Vibramycin)
Description Used if Chlamydia is the cause of the endometritis. Inhibits protein synthesis and thus bacterial growth by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria.
Adult Dose 100 mg PO/IV q12h
Pediatric Dose <8 years: Not recommended
>8 years: 1-2 mg/lb PO/IV q12h
Contraindications Documented hypersensitivity; severe hepatic dysfunction
Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Pregnancy D - Unsafe in pregnancy

Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
American Academy of Pediatrics states that doxycycline is compatible with breastfeeding


Drug Name Ertapenem (Invanz)
Description Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin binding proteins. Stable against hydrolysis by a variety of beta-lactamases including penicillinases, cephalosporinases, and extended spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.
Adult Dose 1 g qd for 14 d if given IV and 7 d if given IM; infuse over 30 min if given IV
Pediatric Dose Not established
Contraindications Documented hypersensitivity to drug or amide-type anesthetics
Interactions Probenecid may reduce renal clearance of ertapenem and increase half-life but benefit is minimum and does not justify coadministration
Pregnancy B - Usually safe but benefits must outweigh the risks.

Precautions Pseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel





FOLLOW-UPSection 8 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References



In/Out Patient Meds

Patient may be discharged without antibiotic therapy after being afebrile for at least 24 hours and with a benign physical examination.
Further outpatient therapy has proved to be unnecessary.

Complications

Wound infection
Peritonitis
Adnexal infection
Parametrial phlegmon
Pelvic abscess
Pelvic hematoma
Septic pelvic thrombophlebitis

Prognosis

Nearly 90% of women treated with an approved regimen note improvement in 48-72 hours.

Patient Education

For excellent patient education resources, see eMedicine's Women's Health Center and Pregnancy and Reproduction Center and Sexually Transmitted Diseases Center and the patient education articles Pelvic Inflammatory Disease, Sexually Transmitted Diseases, Cesarean Childbirth, and Dilation and Curettage (D&C).



MISCELLANEOUSSection 9 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


Medical/Legal Pitfalls

Prophylactic antibiotics reduce the incidence of postpartum febrile morbidity in patients undergoing cesarean delivery.
Single-agent cephalosporin therapy of the first- or second-generation type is considered the best choice.

Special Concerns
Current research is evaluating the timing of administration of cephalosporin prior to skin incision versus at cord clamp for prevention of postcesarean infectious morbidity.

Another topic of research is the preoperative use of povidone-iodine vaginal preparation prior to cesarean delivery.



REFERENCESSection 10 of 10 Authors and Editors Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous References


Cunningham FG. Infection and disorders of the puerperium. In: Cunningham GF, MacDonald PC, Leven KJ, et al, eds. Williams Obstetrics. 20th ed. Stamford, Conn: Appleton & Lange; 1997:548-55.
French L. Prevention and treatment of postpartum endometritis. Curr Womens Health Rep. Aug 2003;3(4):274-9. [Medline].
French LM, Smaill FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev. 2004;CD001067. [Medline].
Ledger WJ. Post-partum endomyometritis diagnosis and treatment: a review. J Obstet Gynaecol Res. Dec 2003;29(6):364-73. [Medline].
Maharaj D. Puerperal pyrexia: a review. Part I. Obstet Gynecol Surv. Jun 2007;62(6):393-9. [Medline].
Gudas JM, Fridovich-Keil JL, Datta MW, Bryan J, Pardee AB. Characterization of the murine thymidine kinase-encoding gene and analysis of transcription start point heterogeneity. Gene. Sep 10 1992;118(2):205-16. [Medline].
Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol. May 2007;196(5):455.e1-5. [Medline].


Endometritis excerpt

Article Last Updated: Aug 15, 2007


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what is chronic endometritis and how does it affect fertility?


Endometritis is an inflammation and/or irritation of the endometrium (lining of the uterus).

The usual cause of endometritis is infection. This includes chlamydial or gonococcal endometritis, frequently occurring among patients with salpingitis; tuberculous endometritis; purulent endometritis; and endometritis following surgery or other gynecological procedures that require insertion of medical instruments.

Most cases of endometritis resolve with adequate antibiotic therapy. Untreated endometritis can progress to more serious infection and result in complications with pelvic organs, reproduction, and general health.  (+ info)

I'm taking Flagyl 500mg twice a day for ten days for Endometritis is it safe to breastfeed?


  (+ info)

Difference between endometritis and PID?


I'm doing a literature review about the consequences of abortion and came across endometritis and Pelvic Inflammatory Disease (PID).

Can someone please explain to me what is the difference between the two? Sounds like they are almost the same to me..

Thanks!
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  (+ info)

Endometritis tests and treatment please help ?


ok i was in the ER because i was in alot of pain the other night they said i was ok checked me out of the ER gave me medication and told me to follow up with my OBGYN and ask to get tested for endometritis i dont knw how to spell it so please dont tell me how to spell ok can anyone tell me what this is hows its tested for and what the treatment is and how it will effect me
does this effect having children as well?
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The condition is endometriosis. Why would you not want to know how to spell it? At this point, you should not feel that you have endometriosis because you haven't been screened for it. This could be something else entirely. The ER doc was making a suggestion based on your symptoms.

In endometriosis, the tissue that lines the uterus begins to grow outside the uterus and can be found anywhere inside the pelvis and can sometimes be found in places such as the intestines and the bladder.

There's no test for it. The only reliable way is to perform laparoscopy and collect a biopsy specimen. But this is an expensive surgical procedure and if you don't want to go this route, your OB/Gyn can ask you questions and perform an exam then make a probable diagnosis based on findings, your symptoms, your answers and your health history. Imaging like ultrasounds and MRIs can't diagnose endo but can rule out cysts and such that could cause your symptoms.

As far as how it will affect you, it can cause infertility in a percentage of women but this may depend on the locations of the overgrowths, such as on the ovaries or inside the fallopian tubes. If you like, click on the link below and you can find out more about it.

http://www.endometriosis.org/endometriosis.html  (+ info)

Possible PID or endometritis postpartum?


I have been having pelvic pain and some abdominal and lower back pain for the past 4 weeks already, Also when i urinate i have spotting and it sometimes burns. Could i possibly have an infection like PID or endometritis? Or if anyone knows what else this could be. I am scared bc i dont want this to cause me to be infertile. I want to know also how long it takes for these infections to cause infertilty.
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  (+ info)

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