Acute endometritis

　　Types of bacteria that cause infection

　　Staphylococcus, Escherichia coli, Streptococcus, anaerobic bacteria, in addition to gonococci. In addition, there are mycoplasmas and other pathogenic organisms.

　　1. Tuberculous

　　Endometritis is caused by tuberculosis bacteria, and is often secondary to salpingitis.

　　2. Non-tuberculous

　　Endometritis is more common, caused by general pathogenic bacteria, and is common during the menstrual period, after abortion, and after childbirth: such as retained placenta and amniotic membrane during childbirth, sexual intercourse during the menstrual period, long-term uterine bleeding, incomplete abortion infection, unsterile gynecological examination, ascending infection from intrauterine operations such as induced abortion and various vaginal surgeries, cervicitis, and vaginal infection, ascending infection from endometrial polyps or submucosal fibroids, and infection caused by necrosis.

　　Acute endometritis can further develop into severe infection, leading to suppuration, extensive necrosis, and can even involve the underlying myometrium, resulting in acute uterine myometritis, salpingitis, and pelvic inflammatory disease, which can worsen the condition. Chronic cases also show similar symptoms, and may also have symptoms such as excessive menstrual bleeding, lower abdominal pain, and obvious lumbar sacral distension. Acute endometritis may cause serious consequences such as diffuse peritonitis, sepsis, and infectious shock.

　　According to the medical history, clinical manifestations, and signs, it is easy to diagnose. During the speculum examination, it is best to take uterine cavity effluent for bacterial culture and drug sensitivity test, and at the same time, smear examination should be performed for bacterial detection, for the reference of drug use. It should be avoided to repeat vaginal examination to prevent the spread of infection.

　　The onset is acute, with chills and even shivering, fever (38-40℃), rapid pulse, general weakness, sweating, severe lower abdominal pain, prolapse, lumbago, a large amount of bloody, purulent, or watery leukorrhea, and an unpleasant smell. Postpartum infection may result in lochia with mud-like color.

　　Signs

　　The patient has lower abdominal tenderness, and the speculum examination shows a large amount of purulent or dirty bloody smelly secretions溢出，double-tract examination shows cervical pain, the uterine body is enlarged, soft, and tender, and the leukocyte count and neutrophil count are increased in the test.

　　1. The causes of infertility that can be caused by this disease include

　　1. After the sperm enters the uterine cavity, inflammation factors such as bacterial toxins and leukocyte phagocytosis cause sperm death or reduced motility, reducing the number of sperm entering the fallopian tube and affecting fertility.

　　2. The fertilized egg is not easy to implant in the inflammatory endometrium, or the implantation is obstructed due to antifertility factors, leading to infertility.

　　3. The implantation of the fertilized egg is not stable, which is very prone to abortion, leading to infertility.

　　Self-examination for chronic endometritis

　　II. The main symptoms of this disease are

　　1. Vaginal bleeding or irregular menstruation.

　　2. About half of the patients have lower abdominal pain or a sensation of descent.

　　3. Increased leukorrhea.

　　4. A few patients may have fever.

　　III. The main signs are

　　1. The uterus may be tender and possibly enlarged.

　　2. There may be thickening and tenderness of the paracervical tissue.

　　About 20% of patients with chronic endometritis have no symptoms at all and are discovered by doctors during gynecological examinations.

　　IV. Main etiology

　　1. Although the endometrium has a cyclical shedding, its basal layer does not shed with it. Once there is chronic inflammation in the basal layer, it can cause long-term infection of the functional layer of the endometrium, leading to chronic endometritis.

　　2. Long-standing salpingo-oophoritis or severe cervicitis can lead to chronic endometritis.

　　3. Intrauterine devices can cause chronic endometritis.

　　4. Small placental residues or poor healing of the placental attachment site after delivery or abortion are often the causes of chronic endometritis.

　　5. Submucosal fibroids and mucosal polyps can also cause chronic endometritis.

　　6. Chronic endometritis without obvious etiology can also exist, and the pathogens are often from the vagina and cervix.

　　Signs

　　Patients have lower abdominal tenderness. Speculum examination shows a large amount of purulent or foul-smelling, bloody discharge溢出 from the cervix. Bimanual examination shows cervical pain on lifting. The uterine body is enlarged, soft, and has obvious tenderness due to congestion and edema. The laboratory test shows an increase in total white blood cells and neutrophils.

　　Diagnosis is easy based on medical history, clinical manifestations, and signs. During speculum examination, it is best to take uterine cavity discharge for bacterial culture and drug sensitivity test, and at the same time, smears should be examined for bacteria to provide reference for drug use. Repeated vaginal examinations should be avoided to prevent the spread of infection.

　　I. Foods that are good for patients with acute endometritis

　　1. Strengthen nutrition, eat more dietary foods rich in protein and vitamins, such as chicken, lean meat, shrimp, milk, tofu, beans, etc.; eat less fat and sugar; the taste should be light, and salt should be used sparingly. For those with increased leukorrhea, more leeks, broad beans, millet, tofu, lotus seeds, walnuts, and white fungus can be eaten.

　　2. Diet should be easy to digest, with liquid or semi-liquid foods that are rich in calories, high in protein, and contain a variety of vitamins. Those who cannot eat should receive intravenous nutrition and fluid supplementation, and attention should be paid to correcting electrolyte imbalance and acidosis.

　　II. Foods that are not good for patients with acute endometritis

　　Avoid spicy, smoking, alcohol, and other刺激性 foods and condiments. Because these foods can all cause inflammation of the reproductive organs and increase vaginal blood flow.

　　I. Prevention of acute endometritis

　　Acute endometritis often occurs after abortion or delivery due to the retrograde infection of the uterine wound, so active treatment of reproductive tract inflammation before pregnancy, and attention to personal hygiene after abortion and delivery can play a certain role in preventing the occurrence of acute endometritis.

　　1. Comprehensive gynecological examination should be conducted before and during pregnancy to detect and treat acute and chronic inflammatory diseases of the reproductive tract in a timely manner, preventing bacterial ascending infection after abortion or delivery.

　　3. Choose a regular hospital for abortion surgery or childbirth. Inadequate disinfection during surgery or delivery is an important cause of acute endometritis, which should be paid attention to.

　　4. Pay attention to personal hygiene after childbirth or post-abortion surgery, do not use unclean toilet paper, change sanitary napkins in time, and prohibit sexual intercourse.

　　5. As pregnant women, prenatal checks should be regularly conducted at designated hospitals, receive prenatal health guidance, actively treat chronic diseases such as malnutrition and anemia, and enhance physical fitness. Sexual intercourse is prohibited in the late stage of pregnancy. Pay attention to diet and nutrition after childbirth, eat easily digestible, nutritious food rich in protein and vitamins, and maintain a good physical condition. Take a semi-recumbent position as much as possible when lochia has not been completely discharged to facilitate the discharge of lochia.

　　6. General women should also pay attention to personal hygiene during their daily lives, and sexual intercourse should be absolutely prohibited when there is vaginal bleeding.

　　At the same time, rest in bed, it is advisable to take a semi-recumbent position to limit the inflammatory exudate to the lowest part of the pelvis and facilitate the discharge of lochia; keep the perineum clean, wash the perineum daily and change underwear, prevent repeated infection; in terms of diet and nutrition, drink more water, eat a diet rich in protein and vitamins; during the illness, sexual intercourse should be prohibited; if the patient is a postpartum woman, do not close the door due to postpartum or fever, and keep the living room warm and ventilated, with fresh air, and do not wear too thick clothes to prevent excessive sweating, the clothing and bedding should be warm and cool. During the treatment, patients should learn to observe the changes in vaginal discharge or lochia volume, color, quality, and smell, as well as the changes in abdominal pain, to judge whether the treatment is effective.

　　II. Prevention of Chronic Endometritis

　　Chronic endometritis has a relatively low incidence rate, but once a patient is infected, it can bring many impacts on life and work, and also cause a lot of pain to the patient himself, so we should actively prevent its occurrence. First of all, we should pay attention to menstrual hygiene, strictly prohibit sexual life during menstruation to prevent pathogenic bacteria from taking advantage of the opportunity to invade. Childbirth and intrauterine surgery should be done in strictly disinfected regular hospitals to prevent direct contamination during surgical operations. Women with possible infections should be given prophylactic anti-inflammatory treatment.

　　Patients with acute endometritis should be treated promptly and thoroughly to avoid the disease from becoming chronic due to delayed healing. In daily life, they should maintain a pleasant mood, pay attention to nutrition, combine work and rest, enhance their own resistance, and improve their physical quality.