Endometritis is a common inflammatory disease of the uterus.
There are several forms of this disease.
The acute form is accompanied by high fever and sharp abdominal pain, bloating.
However, the course of endometritis is not always stormy, most often the disease is sluggish, showing no obvious symptoms.
This sluggish process is a common cause of infertility among young women.
The essence of the pathology and causes
Chronic endometritis - this is a continuous inflammation in the inner layer of the uterus - the endometrium.
First, the inflammatory process can be localized only in the vagina and on the cervix, then, rising up, the inflammation affects the endometrium.
Possible causes of chronic endometritis:
- sexually transmitted infections that were not treated on time,
- complete absence of treatment of the acute form of the disease or self-treatment,
- radiation therapy of the pelvic organs,
- constriction of the cervix,
- abortion or other intrauterine interventions, as a result of which infectious pathogens were introduced into the tissue of the organ.
Symptoms of the disease
The chronic form of the disease is characterized by an irregular menstrual cycle, constant aching and drawing pains in the lower abdomen, not associated with menstruation.
Also, the disease causes a violation of the cycle, provokes bleeding between periods.
It is estimated that in 70% of cases chronic endometritis occurs practically asymptomatic and manifests itself in the form of long-term effects, such as problems with conceiving and carrying a fetus.
Can I get pregnant?
The chronic form of this disease is dangerous because a woman is not in a hurry to see a doctor without experiencing acute painful symptoms..
Such a delay leads to the development of pathologies of the inner layer of the uterus, the endometrium is no longer able to perform its functions in full.
It is believed that women suffering from chronic endometritis have little chance of conceiving a child and there are two main reasons for this.:
- The inner layer of the uterus in the process of the disease changes its structure, is deprived of normal blood circulation and is reborn. Altered tissues are not able to receive a fertilized egg. Even if the embryo can be implanted, there is an extremely high risk of miscarriage, which persists throughout the entire gestation period.
- The inflammatory process during pregnancy does not pass and does not weaken. At the same time, the pathogens of inflammation affect not only the uterus, but also the embryo. As a result, the embryo is rejected and, as a result, miscarriage occurs.
Chronic endometritis is one of the most common causes of infertility..
It is reliably known that in almost half of the cases of inability to have children, the cause is precisely chronic endometritis.
How does it affect the course of pregnancy?
This disease can cause serious complications during pregnancy.:
- The so-called habitual miscarriage, when the patient loses the child for up to 28 weeks from 2 times in a row. Chronic endometritis creates a very high risk of miscarriage at any stage of pregnancy.
- Disruption of the development of the embryo. This is due to the fact that the damaged endometrium lacks sufficient blood circulation. The fruit does not receive the required amount of oxygen, nutrients and vitamins. A child can be born with various pathologies of internal organs.
At the initial stage, it is necessary to identify the cause of the uterus lesion, determine the causative agent of inflammation and reduce its activity. To do this, the doctor prescribes antibiotics, taking into account the sensitivity of the identified microorganisms to them.
In parallel, measures are being taken to correct the patient’s immunity.
At the second stage, the structure and functions of the endometrium are restored and the consequences of its damage are eliminated.:
- Physical procedures are prescribed to restore blood circulation in the endometrium, renew its cells and increase susceptibility to hormones.
- Hormone replacement therapy is carried out to suppress the pathological proliferation of connective tissue and stimulate the functional activity of the endometrium.
- Appointed drugs for metabolic therapy. It is aimed at enhancing the metabolism in endometrial tissues and eliminating the effects of oxygen starvation.
The effectiveness of treatment is assessed by the following parameters.:
- the disappearance or weakening of the activity of the causative agent of inflammation,
- restoration of the echographic picture of the endometrium,
- the disappearance or reduction of the clinical manifestations of the disease,
- endometrial tissue structure restoration.
Treatment of the endometrium should be organized in the early stages, as the neglected disease can lead to irreversible consequences, such as the threat of miscarriage, placental insufficiency, the formation of adhesive processes and polyps in the uterus.
Chronic endometritis and IVF
There is no clear algorithm for working with patients suffering from chronic endometritis.
However, there are general recommendations.:
- It is advisable not to carry out medical stimulation of the cycle to transfer the embryo into the uterus, since during stimulation with chronic endometritis, fluid may collect in the uterine cavity,
- in the chronic form of the disease, the endometrium is very fragile, the transfer of more than one embryo and their successful implantation can lead to problems with gestation and the constant threat of abortion,
- After the embryo is transferred to the uterus, the patient is prescribed drugs that inhibit blood clotting and vitamins.
These job criteria contribute to successful results. on the IVF programand also help to bring the pregnancy to its logical conclusion.
Can I become a mom after treatment?
After successful treatment of chronic endometritis, about 70% of patients successfully acquire children.
Pregnancy after the treatment of this disease should be especially carefully observed, at least 2 times a month.
If there is a threat of premature termination, progesterone-based drugs are prescribed that preserve pregnancy.
Pregnant women with chronic endometritis should be extremely careful about their health and well-being.
Features of the disease
The uterus is an important element of the reproductive system, where during the cycle the soil is prepared for embryo adoption, and after conception a new life develops. Inside the genital organ must remain as sterile as possible. There is no such variety of microorganisms as in the vagina or intestines. Natural protection of the uterus is the neck. Throughout the menstrual cycle, it forms mucus, which blocks the entrance to bacteria and viruses. The cause of inflammation of the uterine lining is often sex during menstruation. Endometritis can also be caused by interventions (abortion, IUD installation, childbirth, caesarean, hysteroscopy) or infection with venereal diseases.
There are two forms of endometritis: acute and chronic. Distinguishes their intensity of signs and duration of flow. In primary inflammation, acute endometritis occurs. However, its manifestations (hyperthermia, chills, abdominal pain, long periods) are often confused with prolonged menstruation and cold. Being without proper attention, the disease takes a chronic form after 1-2 weeks. The peculiarity of this pathology is that it is difficult to recognize by symptoms, and can only be diagnosed during examination. In this case, the disease continues to progress, disrupting the functionality of the reproductive organs and causing irreversible changes.
Patients often confuse concepts such as endometriosis and endometritis, their difference in the nature of the disease. Endometriosis is a hormone-dependent pathology, in which the endometrium grows in an unforeseen place. With endometritis, the mucous does not grow, but becomes inflamed.
Symptoms and diagnosis
When the disease goes from acute to chronic, its symptoms disappear. At this moment, an illusion of recovery is created, which women usually take to improve their well-being. Pathology is accompanied by insignificant yellowish vaginal discharge that does not cause much discomfort.
During menstruation and sexual intercourse, pain is felt, which is also usually not paid attention. Over time, the progressive disease disrupts the menstrual cycle, causing scanty menses, alternating with profuse bleeding. Infertility culminates in pathology, forcing the patient to still seek medical help.
To diagnose endometritis on time, you need to regularly visit a gynecologist with preventive visits. In the initial stage, pathology is hardly noticeable. It is important to consult a doctor already with minor complaints. Gynecologist collects anamnesis and manual examination. During palpation, it is noted that the uterus is sealed and enlarged. To confirm the diagnosis, diagnostic manipulations should be performed:
- definition of vaginal microflora,
- linked immunosorbent assay,
- Pelvic ultrasound,
- hysteroscopy and biopsy
- PCR diagnostics.
To reliably determine that the uterine lining is inflamed, the pipe biopsy will help. The resulting cells are sent for histological examination, which gives an accurate result.
How does endometrial inflammation affect conception?
In planning a pregnancy, it is important that the reproductive organ be healthy. Of course, the ovaries, fallopian tubes and cervix are important in the process. However, the carrying of the fetus, its nutrition and growth occur in the uterus. For the birth of a healthy child, the functional layer must have a certain thickness and structure. Pathologies of the uterine lining may cause changes in the structure of the placenta or directly affect the growing body.
- Infertility with endometritis is explained by the fact that the mucous membrane cannot receive the embryo. Even with the penetration of sperm and fertilization of the egg, as well as passable fallopian tubes, the fetal egg cannot attach to the wall of the uterus. The inflamed mucosa thickens, expands, is replaced by connective tissue. Often, polyps, adhesions, cysts form here. In such conditions, implantation is impossible.
- If the conception did happen, and the embryo managed to find the most favorable area of the uterine mucosa for attachment, there is no guarantee that the pregnancy will end in childbirth. With an increase in the muscular organ, a part of the infant’s place may fall into an unfavorable zone covered with connective tissue. As a result of circulatory and nutritional disorders, miscarriage occurs.
- If you get pregnant with endometritis, you need to be alert. There is a risk that an infectious object from the uterus enters the fetal membranes. As a result of infection of the embryo, the natural processes of its growth and development will be disrupted.
Treatment when planning pregnancy
During the diagnosis of endometritis, an analysis is performed in parallel, which determines the sensitivity of pathogen microorganisms to drugs. In most cases, the patient is prescribed broad-spectrum antibiotics, antiviral, antiprotozoal, and immunomodulatory drugs.
For the prevention of adhesions, absorbable drugs are recommended, and in order to normalize hormonal levels - oral contraceptives. The advantage of large-scale treatment is that it can be carried out on an outpatient basis. Only in some neglected cases a woman may need surgery requiring hospitalization.
During the treatment of chronic endometritis pregnancy planning is impossible. Firstly, the conception that took place may be complicated, and secondly, the majority of the drugs used are incompatible with the bearing of the fetus.
Can I get pregnant with chronic endometritis?
Self disease is not an obstacle to conception. In the early stages of the disease, the ovaries are running smoothly, and some parts of the mucosa are still ready to receive the embryo. However, doctors categorically do not recommend planning a pregnancy for chronic endometritis, since conception can result in miscarriage, stillbirth, detachment of the placenta, congenital anomalies of the fetus and other unpleasant consequences.
For 10% of patients, chronic metroendometritis, in which myometrium is involved in the inflammatory process, leads to infertility. However, this advanced form of the disease occurs infrequently. It is safer and more prudent to plan a pregnancy after chronic endometritis when the treatment is completed.
Can I get pregnant after treating endometritis?
About 60-70% of women in whom endometritis was detected, after treatment, do not experience problems with conception. They easily become pregnant, bear and can give birth naturally, if there are no other barriers for this. Endometritis-related diseases are found in a number of patients, after treatment of which the long-awaited conception also occurs.
With the complication of inflammatory disease and the formation of adhesions in the mouth of the fallopian tubes to conceive naturally will not work. This condition is corrected surgically, and if necessary, assisted reproductive technologies are used.
It is possible to plan a pregnancy after endometritis in the event that a repeated study shows that a woman is healthy. You can take tests and perform a biopsy no earlier than 2 weeks after the end of the course of using antibiotics. It is recommended to begin conception only after complete removal of the active component of drugs from the body.
IVF after treatment
Inflammation of the uterine mucosa is not an indication for the use of assisted reproductive techniques. IVF and endometritis are mutually exclusive concepts. When carrying out an in vitro fertilization protocol, the uterine mucosa must not only be healthy, but also have a certain thickness. If it is inflamed, even the best embryo conceived in a test tube will not be able to attach.
Treatment of chronic endometritis before IVF is mandatory. After recovery, the woman has a chance of natural conception, the probability of which is no less than with IVF (if there are no other problems). Therefore, after the treatment, the patient is given time to become pregnant independently.
In some cases, the IVF procedure after treatment of endometritis is the only possibility of the implementation of reproductive function. This happens when the appendages are involved in the inflammatory process. Inflammation of the fallopian tubes may be complicated by the formation of adhesions, atrophy of fimbriae, the formation of hydrosalpinxes and sactosalpinxes. In this case, an operation is performed, after which in-vitro fertilization is performed.
What is endometritis
The inner surface of the uterus is covered with a mucous membrane - endometrium. A number of pathological causes can lead to the formation of an inflammatory process on it - endometritis, which can be acute or occur in the chronic stage.
The penetration of infection along the ascending pathways into the uterine cavity can be triggered by the following circumstances:
- Childbirth, postpartum surgical procedures,
- Cesarean section,
- Miscarriages or artificial abortions,
- The consequences of a general infectious disease of the body with the transmission of infection through blood or lymph,
- Diagnostic or therapeutic medical manipulations with penetration into the uterus,
- Sex life during menstruation,
- Use of intrauterine contraceptives,
- Sexually transmitted infections.
Have you heard about bacterial vaginitis? Quite a common disease today, details here.
Not to notice the onset of this disease is simply impossible - it is accompanied by a sharp rise in temperature, chills, sharp pains in the lower abdomen. Often, pain is also given in the groin or sacral area. There are serous-purulent discharge from the vagina, in a sharp unpleasant odor, sometimes mixed with blood.
With the defeat of the uterus mucous gonorrheal pathogens possible prolonged bleeding, which is often confused with excessively prolonged menstruation.
The acute phase of the disease can last a week or more, most often requires hospitalization. As a rule, the disease leads to rejection of an already existing fetus or its fetal death. The question of whether it is even possible to get pregnant with endometritis in its acute phase is sexual intercourse until it is cured is strictly prohibited.
Timely onset and quality treatment, most often leads to recovery. One of the most important tasks at this stage is to prevent the disease from becoming chronic.
Is there any chance of a healthy pregnancy with endometritis?
Can a woman suffering from a chronic form of the disease, hope for a successful conception and childbirth? Doctors are unanimous on this point - chronic endometritis and planning of pregnancy are in no way combined, there are very few chances to bear and give birth to a healthy child.
First of all, the reborn mucosa of the uterus cannot become a reliable basis for anchoring the fetus on it, even if fertilization occurs. It happens that the egg can stay on the affected area of the endometrium, but the risk of miscarriage is extremely high and will continue throughout the entire gestation period.
Most often this happens at the initial stage, while some women do not even know that they could already become a mother. Therefore, if someone sins on his "infertility" - this is another reason to undergo a thorough examination by a specialist.
The second serious threat - with the beginning of pregnancy, the inflammatory process does not fade, but continues to actively develop, while affecting not only the walls of the uterus, but also passing on to the growing fetus. Most often, this also ends in miscarriage at various periods, cases of intrauterine intoxication and the death of the fetus are not excluded.
A disease like colpitis has many variations, one of which can be found in our article.
Can a woman after having an ectopic pregnancy have children? Under the link you will find the answer.
Do not lose heart - everything is fixable!
After such heavy conclusions, women should be reassured - The overwhelming number of cases of chronic endometritis can be cured completely, after which you can plan to increase the family.
Treatment of the disease is usually carried out without hospitalization, on an outpatient basis, and includes a course of therapeutic procedures with the use of antibiotics, carefully selected by the doctor, taking into account the pathogenic microflora of the genital organs.
Reception of anti-inflammatory drugs combined with drugs that raise the immune system. In some cases, intrauterine drug administration is practiced. Surgical interventions are extremely rare, with excessively advanced forms of the disease and the lack of a therapeutic effect on drugs.
With the positive dynamics of treatment, removal of the inflammatory process, carry out recovery procedures (physiotherapy and phytotherapy), which promotes the regeneration of endometrial cells, and the restoration of its original properties.
The general course of treatment can be up to four months, the first significant findings are made after the first two. Perhaps this may seem too long, but the results are worth it: pregnancy after endometritis, detected and treated in time, is not just possible, but also perfectly safe for the future mother and baby.
Disease prevention, regular check-ups with specialists, a healthy lifestyle, optimism and faith in their inexhaustible feminine opportunities are the key to a future happy motherhood.
1. Introduction to terminology
Endometritis is an infectious-inflammatory disease of the inner surface of the uterus with involvement of the functional and growth (basal, cambial) layer of the endometrium in the process. With the spread of infection through the vessels (blood, lymphatic) in the muscle layer develops metroendometritis (acute or chronic).
In the structure of inflammatory diseases of the pelvic organs (PID) of the Russian Federation, the proportion of endometritis is about 34%, and the maximum frequency of this pathology occurs at the age of 26-35 years, that is, the peak of the reproductive function of a modern woman.
In this case, chronic endometritis is the cause of infertility, according to various data, up to 68% of cases, and in women with recurrent miscarriage - up to 70%. In 37% of cases of unsuccessful IVF attempts, their cause is precisely this pathology. With unsuccessful attempts at IVF, the risk of developing inflammation in the uterus cavity increases by 60%.
The incidence of endometritis after spontaneous urgent physiological labor is 1-2%, after pathological and premature, this figure rises to 6%, after a cesarean section, to 12%.
If a woman has chorioamnionitis, every 5 cases of delivery is accompanied by postpartum endometritis. Thus, statistical indicators indicate the prevailing role of endometrial lesions as the cause of impaired female reproductive function.
The main cause of endometritis / metroendometritis is an infection that enters the sterile cavity of the uterus in various ways, which will be discussed below.
According to etiology, endometritis is isolated:
- 1 Nonspecific pathogens of which are conditionally pathogenic flora.
- 2 Specific pathogens of which are:
- Viruses - HSV, TsMV, VEB.
- Bacteria - Mycobacterium tuberculosis, Neisseria gonorrhoeae, mycoplasma, chlamydia - Chlamydia trachomatis.
- Mushrooms - Candida, Blastomyces dermatitidis, Coccidioides immitus, Cryptococcus glabratus,
- Protozoi - Toxoplasma gondii, Schistosoma haemotobium,
- Parasites - Enterobius vermicularis.
- 3 Mixed infection, polymyrobic associations (2-3 species of bacteria and viruses). The most frequent option in practice.
The pathways of infection with endometritis and metroendometritis can be:
- 1 Ascending (acute vulvovaginitis, cervicitis).
- 2 Hematogenous, lymphogenous pathway, in which infectious agents enter the endometrium with blood and lymph.
4. Predisposing factors
The risk factors for disease include:
- 1 Invasive (diagnostic and therapeutic) procedures in the uterine cavity, such as abortion, hysteroscopy, hysterosalpingography, endometrial aspiration biopsy, in vitro fertilization, diagnostic scraping.
- 2 Inflammatory diseases (colpitis, cervicitis, salpingoophoritis, genital infections).
- 3 Intrauterine device.
- 4 Sexual contacts during menstrual period, STIs.
- 5 Non-compliance with the rules of personal hygiene, especially in the postpartum period.
- 6 Decreased immunity (HIV infection, AIDS, frequent hypothermia, chronic extragenital, endocrine pathology, cytotoxic drugs, glucocorticosteroids).
Morphological variants of chronic endometritis (by Smetnik V.P.)
- 1 Atrophic - accompanied by a decrease in the thickness of the endometrium, the proliferation of connective tissue.
- 2 Cystic - characterized by the formation of multiple cysts with compression by the connective tissue of the glands of the endometrium, the cysts are filled with thick contents.
- 3 Hypertrophic is accompanied by excessive growth and endometrial hyperplasia.
5. Endometritis as a cause of infertility.
As noted earlier, the most common complication of pathology is miscarriage, including habitual miscarriage.
Chronic endometritis does not interfere with fertilization, a woman may become pregnant, but then the pregnancy stops. In the pathogenesis of the main role played by:
- Inflammatory changes in the endometrium. One way or another, the blastocyst attaches to a modified endometrium, which is not always able to provide adequate nutrition and protection of the ovum.
Often, foci of necrosis are found in the uteroplacental region, severe inflammatory infiltration, the endometrium itself experiences a state of hypoxia and ischemia, and its blood supply is disturbed.
- Altered immune response of the body. The interaction of the fetus and the mother includes many links, one of which is the direction of "work" of cellular immunity in a different way.
As a result, the fetus is not perceived by the mother’s body as an alien agent and is safely nursed for the required time.
In chronic inflammation on the background of prolonged irritation of the endometrium, the ovum is perceived as a factor of aggression.
- Violation of the secretory function. With the disease, there is a decrease in the amount of specific proteins produced by the glands of the endometrium, aimed at the full decidualization of the endometrium (that is, preparing it for the adoption of the ovum).
- In chronic inflammation, endometrial and stromal receptors are not able to fully perceive changes in the levels of estrogen and progesterone.
This also worsens the course of pregnancy. The resulting blastocyst (future fetus) tries to attach itself to an unhealthy endometrium (with poor nutrition, small thickness, with foci of necrosis).
After attaching the fetal egg begins to lack nutrients, it is attacked by the immune cells of the mother's body, trying to rid it of additional irritation. The most frequent outcome of all these pathological processes is spontaneous abortion.
Patients have several possible outcomes of pregnancy:
- 1 Spontaneous abortion.
- 2 An incomplete miscarriage (missed abortion).
- 3 Prolongation and normal gestation.
6. Endometritis and pregnancy
Not always the result is so sad. Pregnancy with chronic endometritis is quite possible. For its occurrence, the intensity of the inflammatory process, the depth of the lesion of the endometrium and myometrium, the immune and hormonal status of the woman, the duration of the disease are important. Under relatively favorable conditions, pregnancy is prolonged, and the baby develops.
The most common complications during gestation are:
- 1 Chorioamnionitis.
- 2 Preterm labor.
- 3 Malovodie.
- 4 Polygonum.
- 5 Premature (antenatal) discharge of amniotic waters.
- 6 Chronic intrauterine hypoxia.
- 7 Violations of the placentation (central, regional presentation).
- 8 Chronic placental disorders.
- 9 Fetal hypotrophy.
- 10 Postpartum endometritis.
- 11 Intrauterine infection of the fetus.
In the pathogenesis of the above complications are involved:
- 1 The destructive effect of toxins released during the life of microorganisms. It is usually difficult to identify any pathogen, most often it is an association of microorganisms, so it is rather difficult to predict their effect on the developing fetus.
- 2 Inadequate development of structures that provide nutrition to the fetus. As we remember, pregnancy against the background of chronic endometritis develops against the background of insufficient attachment, hypoxia. This affects the quality of the placentation, providing the fetus with nutrients and oxygen. Conditions for hypoxia are created.
- 3 An infection of the amniotic fluid, swallowing which the baby receives its share of microorganisms.
- 4 Amniotic membranes, as a rule, are thinned, the normal exchange of amniotic fluid is absent (violation of vascular permeability) - the result is polyhydramnios or low water, premature rupture of amniotic fluid.
In the prevention of these complications, pregravid preparation plays a major role.
7. Clinical manifestations
Manifestations of the disease both before pregnancy and during it are scarce.
The main signs of chronic endometritis are:
- 1 Unpleasant sensations, moderate abdominal pain, often of a pulling character. Sometimes pain syndrome causes anxiety, is quite pronounced, radiates to the groin area, perineum, sacrum.
- 2 Scanty mucopurulent discharge, often of a serous character from the genital tract, causing itching and burning in the genital area.
- 3 Long subfebrile condition, weakness against its background.
- 4 A woman may experience various menstrual irregularities, heavy menstruation, or, conversely, extremely scarce, rare. Intermenstrual bleeding may occur.
There are no specific symptoms for which a woman could independently suspect endometritis / metroendometritis. It is detected, most often, by chance, or when diagnosing the causes of infertility, habitual miscarriage in a woman.
8. Diagnostic measures
If during the period of pregravid preparation, the diagnostic possibilities of a modern doctor are wide, then during the period of gestation their list is significantly reduced.
The interests of the doctor and the woman are not aimed directly at the diagnosis, but at successfully bringing the new pregnancy to 14-16 weeks, followed by a course of antibiotic therapy.
Diagnostic measures during this period include:
- Anamnesis is important. The doctor will determine if the woman had endometritis before pregnancy, or if she received treatment.
- Microscopic examination of the smear (smear on the flora and GN) is a non-specific method of laboratory diagnostics, allowing to evaluate the prevailing flora of the vaginal contents, the contents of the cervical canal.
- General blood analysis. Mild leukocytosis and elevated ESR may be observed in OAK.
- Real-time PCR, PCR screening for STIs.
- Ultrasound examination is more informative during the preparation period. In pregnancy, the nature of the endometrium and its changes can be assessed only in the first trimester in the early stages. Its heterogeneity, uneven contours, hyperechoic areas, diffuse focal and cystic changes can be detected. The focus of the doctor will be on the state of the ovum and fetus.
- Histological examination of the material obtained by hysteroscopy, endometrial pipe biopsy is the gold standard for diagnosing chronic endometritis and metroendometritis. This study is possible only with pregravid preparation. When pregnancy is not performed.
9. Preparing for pregnancy
Preparing for pregnancy in women with chronic endometritis / metroendometritis includes:
- 1 Confirmation of the diagnosis - histological examination of the material obtained by hysteroscopy, endometrial pipeline biopsy (typical signs are the presence of plasma cells, inflammatory lymphoid infiltrates, fibrosis, hardening of the arteries).
- 2 Combined therapy, including antibacterial, antiviral, antifungal drugs, auxiliary methods. Therapy begins on the first day of menstruation.
- 3 Purpose COCOV, progesterone drugs for at least 3 months.
- 4 If indicated, surgical treatment (curettage, hysteroresectoscopy).
- 5 In the absence of effect, the issue of IVF is considered.
The most common antibiotic combinations are:
- 1 Josamycin + metronidazole,
- 2 Amoxicillin clavulanate + ofloxacin,
- 3 Amoxicillin clavulanate + josamycin,
- 4 Amoxicillin clavulanate + doxycycline,
- 5 Ofloxacin + metronidazole,
- 6 ceftriaxone + azithromycin + metronidazole,
- 7 Levofloxacin + metronidazole,
- 8 Moxifloxacin (monotherapy).
The choice of antibiotics depends on the type of pathogens identified by PCR, with bacposa and simple microscopy. Chlamydia, herpes simplex virus, mycoplasma, CMV, HPV are most commonly found in patients.
Clinical manifestations of endometritis
The disease is dangerous because at first it can be absolutely asymptomatic or so easy that it does not attract the attention of a woman.
Among the symptoms of insidious disease are the following:
- pain in the groin (after exertion or at rest),
- discharge with a specific odor (color varies from white to brown),
- problems with the menstrual cycle (delay, menstruation too long).
Planning for pregnancy after treatment
Start planning pregnancy should be no earlier than the time when repeated research will be conducted. After the expectant mother will undergo a course of treatment, it is necessary to sustain a number of important studies:
- biopsy of the uterine lining,
- Ultrasound of the genitals
- smear on flora,
- blood test.
If, as a result of the examination, it turns out that the uterine mucosa is restored and ready for implantation of the embryo, the young family may begin to try to conceive a child. Good luck!
Signs of endometritis
The disease manifests itself during pregnancy as follows:
- Lower abdominal pain
- Increased body temperature
- Purulent discharge and vagina,
- Pain during sexual intercourse,
Much depends on the type of disease progression. Chronic endometritis may have only 1-2 weak signs. Whereas during acute course a typical clinical picture is formed, forcing the patient to consult a doctor. The chronic form is often diagnosed by chance.
Is conception and pregnancy possible?
Can I get pregnant with endometritis? As mentioned above, potentially this diagnosis leads to infertility. But in the early stages of the development of pathology, getting pregnant is still possible, but this should not be done for a number of reasons, which will be discussed below. Pregnancy with chronic endometritis is especially likely, because throughout its treatment it is necessary to use contraceptive methods.
Can I give birth?
There are no absolute contraindications to childbirth as such with this diagnosis. However, the process can be complicated by various features. In particular, the rupture of the walls of the uterus, as they are thinned. There is also a chance of significant bleeding. There is also a high risk of infection during childbirth, as there is infection in the body. Therefore, it is necessary to treat the disease before planning.
Reproductive Risk Factors
As the disease progresses, the probability of conception is significantly reduced. Over time, infertility develops. Why does this happen, and what mechanisms does infertility have with a given diagnosis?
- Lack of ovulation
- Невозможность прикрепления эмбриона к измененному или неподготовленному в результате гормонального сбоя эндометрию,
- Замирание беременности,
- Выкидыши на ранней стадии ввиду гипертонуса матки.
Thus, although pregnancy is possible, it rarely proceeds normally.
Features of carrying
The main feature of gestation with this diagnosis is that after conception, the process continues to evolve. It affects not only the tissues of organs, but also the fetus. Therefore, although it is possible to get pregnant with endometritis, it is impossible to give birth to a healthy child. This feature leads either to miscarriages at an early stage, or to premature delivery of the fetus with pathologies (rarely).
Pregnancy after treatment
Pregnancy after treatment of chronic endometritis should be planned no earlier than 2-3 months after passing the examinations confirming the cure. Before planning conception, it is necessary to undergo a series of studies:
- Ultrasound of the uterus and pelvic organs,
- Endometrial tissue biopsy,
- Smear on microflora,
- Blood test for hormones.
If all tests and indicators are normal, then you can proceed to the planning of pregnancy. An independent conception is usually possible, but in some cases it is complicated, then progesterone medication is prescribed for 3-6 months. As a result, the thickness of the endometrium and the frequency of its renewal are normalized.
Sometimes additional measures are applied, such as electrophoresis, physiotherapy, UHF. This will avoid the development of adhesions and quickly normalize the condition of the mucous membrane.
Infertility as a complication of the disease
The most common complication of endometritis is the spread of infection beyond the uterus. If untreated, the following organs are infected:
- fallopian tubes,
- pelvic organs.
Purulent endometritis provokes the development of peritonitis, and in some cases sepsis.
Endometritis is a consequence of adhesions in the uterus, small pelvis, intestines, preventing the development of pregnancy, which can not occur with the development of the above complications.
Endometritis leads to the development of adhesions in the uterus
Causes of chronic endometritis
The uterine cavity should ideally be sterile, that is, without pathogenic microorganisms. Protective "gate" is the cervix.
Endometritis and pregnancy are concepts that go badly, and every woman who encounters this is concerned, resulting in a disease.
- Generic activity or postpartum phenomena.
- Cesarean section.
- Abortions, miscarriages.
- Genital tract infections.
- Medical manipulations associated with penetration into the uterine cavity.
- Having sex during menstruation.
- Use of intrauterine contraceptives.
Pregnancy is possible only if the disease is at an early stage of development. A woman who has chronic endometritis and who has managed to conceive a child should be extremely careful about her well-being and the health of the future baby. In addition to the threat of miscarriage, he still faces many dangers. In chronic endometritis, embryonic tissues are damaged, which creates an additional risk of developmental abnormalities.
Inflammation of the uterus leads to the fact that the fetus can not firmly hold it. If the disease affects the fallopian tubes and ovaries, the result may be the following phenomena:
- cessation of ovulation
- non-acceptance of a fertilized egg by the uterus,
- termination of fetal development in the early stages,
- premature termination of pregnancy.
A woman experiences pain in the groin, there are problems with the monthly cycle (menstruation is delayed or lasts a long time), whitish discharge (or yellow, brown) with a specific smell.
Pregnancy in the inflammatory process in the uterus can result in abnormalities in the baby that has been born, which is associated with an intrauterine infection.
Diagnosis and symptoms of the disease
If you diagnose the disease in a timely manner, the woman will have a chance to fully recover and start planning a pregnancy.
There are acute and chronic forms of endometritis. The first develops 3-4 days after the infection has penetrated. For her indicative:
- high temperature
- lower abdominal pain,
- blood or sero-purulent discharge with a characteristic odor,
- pain when trying to urinate,
- rapid pulse.
When the disease enters the chronic stage, the monthly cycle is disturbed, discomfort appears during intercourse, and aching pain in the abdomen. The uterus is thickened and slightly enlarged. These symptoms may not be, so the woman is in no hurry to see a gynecologist, even more triggering the ailment.
Pregnancy with endometritis is possible in a small percentage of cases, but if the disease is not detected at an early stage and the necessary therapeutic procedures are not started, the risk to the health and life of the infant remains high.
Pregnancy should occur under the close supervision of a doctor who prescribes the procedure:
- Temperature measurement For mild illness, it is 37 degrees, for severe - 39 and higher.
- Determining the number of leukocytes and erythrocyte sedimentation rate by passing a complete blood count. The higher these indicators, the more difficult the form of the disease.
- Bakposev materials isolated from the uterine cavity - identifies the pathogen, its sensitivity to antibiotics.
- Detection of antibodies in the blood - makes it possible to determine the presence of an active infection.
- Identification of genes of pathogens of inflammation by PCR studies of the material.
- Swabs on the flora - allow you to determine which organs were subjected to infection.
- Ultrasound of the reproductive organs.
- Hysteroscopy, which determines 1 of 3 variants of the course of endometritis (normal, with necrosis of the decidual tissue, with delayed placental tissue).
- The study of acid-base balance. With endometritis pH
An important condition is to completely get rid of the disease, so as not to give the infection the slightest chance to move from mother to baby.
During the carrying of the child should drink away the course of vitamins and dietary supplements recommended by the doctor, to relax more, to avoid stress and stress, including psychological. To normalize the microflora, prescribed probiotics.
Often a woman who is in an interesting position is sent to a hospital to preserve pregnancy, especially in the early stages.
It happens that the endometrium penetrates the abdominal cavity and grows there, attaching to the ovaries, fallopian tubes, bladder and even the rectum. Blood is poured out of it, inflammation occurs, leaving scar tissue behind. These areas of the mucous layer is very difficult to attach to the embryo after conception, so in many cases miscarriage occurs, IVF is required.
Natural pregnancy after treatment
After recovery, a woman can plan a pregnancy naturally. Hurry with conception is not necessary. You should first improve the body: if possible, go through physiotherapy, balneotherapy, it will not be superfluous to have a gynecological massage, which improves the blood supply to the small pelvis. The body must restore all its functions.
Before conceiving, you should pass all tests, undergo a medical examination, including an ultrasound scan.
Therapy during pregnancy includes taking fortifying vitamin complexes and antibacterial agents (as recommended by the doctor). Effective administration of drugs into the uterine lining.
A woman should be monitored by a gynecologist and visited at least 1 time in 2 months.
If the doctor diagnosed endometritis, do not despair. It is necessary to fulfill all assignments that (according to the standard scheme) include:
Sometimes conservative therapy is combined with curettage to refresh the endometrial layer. If the treatment has borne fruit - inflammation has disappeared, hormonal balance has normalized, menstruation has returned to normal - you can begin planning pregnancy, but not earlier than 2-3 months after all symptoms of the disease disappear.
The treatment of endometritis with folk remedies is sometimes used, therefore we recommend reading additional information on this topic.
Endometritis often develops on the background of a decrease in local and general immunity. Disease prevention activities should include:
- Healthy lifestyle.
- Personal hygiene.
- Stable sex life with 1 partner.
- Condom use.
- Elimination of abortion.
To treat the disease, it is not required to go to the inpatient department of the clinic. Enough ambulatory therapy.
When planning a pregnancy, you should take into account the results of the examinations performed again, to make sure that the treatment was successful, the cycle returned to normal.
Can I get pregnant with the disease
The doctors' answer to this question is unequivocal: with an unhealed chronic endometritis, a woman should not be decided on conception, since the chances of it and carrying a healthy baby in this case are minimal. Reborn mucous membrane of the uterus can not be a reliable basis for securing the embryo in case of successful fertilization.
Pregnancy and endometritis incompatible
During pregnancy with the disease
Sometimes the egg is held in the affected area of the endometrium, but a miscarriage can occur at any time. Most often this occurs at the beginning of pregnancy, when the woman does not yet know about her position. In addition, with the beginning of pregnancy, the inflammatory process is actively developing, affecting the walls of the uterus and moving on to the growing baby. Usually it ends in miscarriage, intrauterine intoxication and death of the embryo.
In order to avoid endometritis, a woman should follow the following guidelines:
- keep the genitals clean
- practice protected sex,
- timely treat any infection, especially related to the sexual sphere,
- take antibiotics after cesarean section, abortion and other complex interventions,
- pass a full examination after childbirth,
- once a year, see a gynecologist,
- timely replace intrauterine devices.
Video: useful information about chronic endometritis
Sometimes a woman for a long time can not make a baby or even get pregnant. Often the cause is endometritis, which does not allow the egg to gain a foothold on the uterine mucosa. However, treatment of this disease often solves the problem and allows you to conceive, bear and give birth to a healthy child.