Endometritis: Difference between revisions

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==Overview==
{{CMG}} {{AE}} {{SHA}}
 
'''Endometritis''' refers to [[inflammation]] of the [[endometrium]],<ref>{{DorlandsDict|three/000035349|endometritis}}</ref> the inner lining of the [[uterus]]. [[Pathology|Pathologists]] have traditionally classified endometritis as either [[Acute (medical)|acute]] or [[chronic (medicine)|chronic]]: acute endometritis is characterized by the presence of microabscesses or [[neutrophil]]s within the endometrial [[glands]], while chronic endometritis is distinguished by variable numbers of [[plasma cells]] within the endometrial [[stroma (animal tissue)|stroma]]. The most common cause of endometritis is [[infection]]. Symptoms include lower abdominal pain, fever and abnormal vaginal bleeding or discharge. [[Caesarean section]], [[prolonged rupture of membranes]] and long labor with multiple [[vaginal examination]]s are important risk factors. Treatment is usually with broad-spectrum [[antibiotic]]s.
 
The term "endomyometritis" is sometimes used to specify inflammation of the endometrium and the [[myometrium]].<ref name="isbn0-7817-5532-8">{{cite book |author=Hubert Guedj; Baggish, Michael S.; Valle, Rafael Heliodoro |title=Hysteroscopy: visual perspectives of uterine anatomy, physiology, and pathology |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2007 |pages=488 |isbn=0-7817-5532-8 |oclc= |doi= |accessdate=}}</ref>
 
== Acute Endometritis ==
Acute Endometritis is characterized by infection. The organisms isolated are most often infection are believed to be because of compromised abortions, delivery, medical instrumentation, and retention of placental fragments. Histologically, neutrophilic infiltration of the endometrial tissue is present during acute endometritis. The clinical presentation is typically high fever and purulent vaginal discharge. Menstruation after acute endometritis is excessive and in uncomplicated cases can resolve after 2 weeks of [[clindamycin]] and [[gentamicin]] [[intravenous|IV antibiotic treatment]].
 
In certain populations, it has been associated with ''[[Mycoplasma genitalium]]''.<ref name="pmid11888591">{{cite journal |author=Cohen CR, Manhart LE, Bukusi EA, ''et al.'' |title=Association between Mycoplasma genitalium and acute endometritis |journal=Lancet |volume=359 |issue=9308 |pages=765–6 |year=2002 |month=March |pmid=11888591 |doi=10.1016/S0140-6736(02)07848-0 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)07848-0}}</ref>
 
== Chronic Endometritis ==
 
Chronic Endometritis is characterized by the presence of [[plasma cells]] in the stroma. Lymphocytes, eosinophils, and even lymphoid follicles may be seen, but in the absence of plasma cells, are not enough to warrant a histologic diagnosis. It may be seen in up to 10% of all endometrial biopsies performed for irregular bleeding. The most common organisms are [[Chlamydia trachomatis]] ([[Chlamydia infection|chlamydia]]), [[Neisseria gonorrhoeae]] ([[gonorrhea]]), Streptococcus agalactiae ([[Group B Streptococcus]]), [[Mycoplasma hominis]], [[tuberculosis]], and various viruses. Most of these agents are capable of causing chronic [[pelvic inflammatory disease]] (PID). Patients suffering from chronic endometritis may have an underlying cancer of the cervix or endometrium (although infectious etiology is more common). Antibiotic therapy is curative in most cases (depending on underlying etiology), with fairly rapid alleviation of symptoms after only 2 to 3 days.
 
Chronic granulomatous endometritis is usually caused by tuberculous. The granulomas are small, sparse, and without caseation. The granulomas take up to 2 weeks to develop and since the endometrium is shed every 4 weeks, the granulomas are poorly formed.
 
In human medicine, pyometra (also a veterinary condition of significance) is regarded as a form of chronic endometritis seen in elderly women causing stenosis of the cervical os and accumulation of discharges and infection. Symptom in chronic endometritis is blood stained discharge but in pyometra the patient complaints of lower abdominal pain.
 
== Pyometra ==
{{main|Pyometra}}
Pyometra describes an accumulation of pus in the uterine cavity.  In order for pyometra to develop, there must be both an infection ''and'' blockage of cervix. Signs and symptoms include lower abdominal pain (suprapubic), rigors, fever, and the discharge of pus on introduction of a sound into the uterus.
Pyometra is treated with antibiotics, according to culture and sensitivity.
 
==See also==
*[[Maternal death]]
*[[Puerperal fever]]


{{SK}} acute endometritis, chronic endometritis, postpartum endometritis, puerperal endometritis


==Overview==
==Overview==
 
Endometritis is classified [[histopathological|histopathologically]] into two subtypes: acute endometritis and chronic endometritis (CE).  Acute endometritis occurs following [[abortion]], [[childbirth]], [[menstruation]], [[curettage]], or [[IUD]] insertion. [[Symptoms]] of acute endometritis may include [[fever]], [[pelvic pain]], and [[vaginal discharge]]. On [[histopathology]], many [[neutrophils]] are seen in the [[endometrial]] [[stroma]] in acute endometritis. Chronic endometritis may cause [[infertility]]. Chronic endometritis (CE) is mostly [[asymptomatic]] but may have vague [[symptoms]]. On [[histopathology]], [[plasma cells]] are seen in the [[endometrial]] [[stroma]] in chronic endometritis (CE). Endometritis is mostly caused by [[infection]] and treated with [[antibiotics]]. Pyometra is a rare disorder with [[pus]] accumulation in the [[uterine]] cavity due to abnormal drainage of the [[uterus]].
==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
There is limited information on the historical perspective of endometritis.  
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
 
==Classification==
==Classification==
Endometritis  may be classified according to [[histopathology]] into two subtypes:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref>  
Endometritis  may be classified according to [[histopathology]] into two subtypes:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref>  


* [[Acute]] endometritis
*[[Acute]] endometritis
* [[Chronic]] endometritis (CE)
**Following [[abortion]], [[childbirth]], [[menstruation]], [[curettage]], or [[IUD]] insertion.<ref name="Hellweg 2010 p.">{{cite book | last=Hellweg | first=G | title=Atlas of endometrial histopathology | publisher=Springer | publication-place=Heidelberg | year=2010 | isbn=978-3-642-01541-0 | oclc=663096526 | page=}}</ref>
**The time following [[childbirth]] until about 6 weeks after [[childbirth]] is traditionally referred to as [[puerperium]] ([[postpartum]]).<ref name="Cunningham 2010 p.">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>


==Pathophysiology==
*[[Chronic]] endometritis (CE)
The exact pathogenesis of [disease name] is not fully understood.
**[[Mycobacterium tuberculosis]] causes a subtype of [[chronic]] endometritis (CE) (chronic [[granulomatous]] endometritis) in some developing countries.<ref name="pmid18842939">{{cite journal| author=Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S | display-authors=etal| title=Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 12 | pages= 4068-70 | pmid=18842939 | doi=10.1128/JCM.01162-08 | pmc=2593260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18842939  }} </ref>


OR
===Pyometra===


It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
*Pyometra is a rare disorder with [[pus]] accumulation in the [[uterine]] cavity due to abnormal drainage of the [[uterus]].<ref name="pmid7284938">{{cite journal| author=Muram D, Drouin P, Thompson FE, Oxorn H| title=Pyometra. | journal=Can Med Assoc J | year= 1981 | volume= 125 | issue= 6 | pages= 589-92 | pmid=7284938 | doi= | pmc=1862642 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7284938  }} </ref>
*Pyometra is caused by:<ref name="pmid25628913">{{cite journal| author=Yamada T, Ando N, Shibata N, Suitou M, Takagi H, Matsunami K | display-authors=etal| title=Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin. | journal=Case Rep Surg | year= 2015 | volume= 2015 | issue=  | pages= 548481 | pmid=25628913 | doi=10.1155/2015/548481 | pmc=4299690 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25628913  }} </ref><ref name="pmid17093350">{{cite journal| author=Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN| title=Spontaneous perforation of pyometra. | journal=Infect Dis Obstet Gynecol | year= 2006 | volume= 2006 | issue=  | pages= 26786 | pmid=17093350 | doi=10.1155/IDOG/2006/26786 | pmc=1581463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17093350  }} </ref><ref name="pmid17093350">{{cite journal| author=Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN| title=Spontaneous perforation of pyometra. | journal=Infect Dis Obstet Gynecol | year= 2006 | volume= 2006 | issue=  | pages= 26786 | pmid=17093350 | doi=10.1155/IDOG/2006/26786 | pmc=1581463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17093350  }} </ref>
**Atrophic [[cervicitis]] due to aging
**[[IUD]] use
**Malignant or benign gynecologic [[tumors]]
**Radiation [[cervicitis]]
*Mostly seen in [[postmenopausal]] women and rarely in the [[premenopausal]] women<ref name="pmid17093350">{{cite journal| author=Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN| title=Spontaneous perforation of pyometra. | journal=Infect Dis Obstet Gynecol | year= 2006 | volume= 2006 | issue=  | pages= 26786 | pmid=17093350 | doi=10.1155/IDOG/2006/26786 | pmc=1581463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17093350  }} </ref>
*The classic triad of [[symptoms]] in pyometra includes:<ref name="pmid17093350">{{cite journal| author=Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN| title=Spontaneous perforation of pyometra. | journal=Infect Dis Obstet Gynecol | year= 2006 | volume= 2006 | issue=  | pages= 26786 | pmid=17093350 | doi=10.1155/IDOG/2006/26786 | pmc=1581463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17093350  }} </ref><ref name="pmid23131215">{{cite journal| author=Shapey IM, Nasser T, Dickens P, Haldar M, Solkar MH| title=Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum. | journal=Ann R Coll Surg Engl | year= 2012 | volume= 94 | issue= 8 | pages= e246-8 | pmid=23131215 | doi=10.1308/003588412X13373405387410 | pmc=3954306 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23131215  }} </ref>
**Lower [[abdominal pain]]
**Purulent [[vaginal discharge]]
**[[Postmenopausal bleeding]]


OR
==Pathophysiology==
 
===Postpartum endometritis===
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
Postpartum endometritis is caused by [[bacteria]] ([[vaginal]] [[microflora]]) ascending from the lower [[genital]] tract during [[labor]].<ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>


OR
*These bacteria colonize the [[cervix]] and then ascend into the lower part of the [[uterus]] and enter the [[amniotic fluid]].
*The amniotic membranes are weakened and ruptured due to the [[collagenases]] and [[proteases]] that are produced.


Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
Artificial or spontaneous rupture of membranes may also happen without [[bacterial]] colonization.<ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>


OR
*In these cases [[bacteria]] may colonize the [[decidua]] and [[amniotic fluid]].
*An amnionitis without deciduitis is caused when [[bacteria]] do not colonize the [[decidua]]. [[Chorioamnionitis]] occurs but the [[uterus]] is not infected.
*Deciduitis may result in the [[infection]] of the [[myometrium]] that may not be diagnosed initially. However, it may not lead to postpartum endometritis with [[antibiotic]] treatment after [[delivery]].


===Chronic Endometritis===
In the normal [[endometrium]], [[B-cells]] are mostly seen in the basal layer.<ref name="pmid9103229">{{cite journal| author=Yeaman GR, Guyre PM, Fanger MW, Collins JE, White HD, Rathbun W | display-authors=etal| title=Unique CD8+ T cell-rich lymphoid aggregates in human uterine endometrium. | journal=J Leukoc Biol | year= 1997 | volume= 61 | issue= 4 | pages= 427-35 | pmid=9103229 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9103229  }} </ref>


[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
*The basal layer is the layer that remains across the menstrual cycle.
*In the [[lymphocyte]] aggregates, [[B-cells]] are the central cells that are surrounded by [[CD8]] [[T-cells]] and [[macrophages]].


OR
In chronic endometritis (CE):<ref name="pmid29960704">{{cite journal| author=Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T| title=Endometritis: new time, new concepts. | journal=Fertil Steril | year= 2018 | volume= 110 | issue= 3 | pages= 344-350 | pmid=29960704 | doi=10.1016/j.fertnstert.2018.04.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29960704  }} </ref>
 
The progression to [disease name] usually involves the [molecular pathway].
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


*[[B-cells]] are seen in the [[endometrial]] functional and basal layers.<ref name="pmid3461701">{{cite journal| author=Tabibzadeh SS, Bettica A, Gerber MA| title=Variable expression of Ia antigens in human endometrium and in chronic endometritis. | journal=Am J Clin Pathol | year= 1986 | volume= 86 | issue= 2 | pages= 153-60 | pmid=3461701 | doi=10.1093/ajcp/86.2.153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3461701  }} </ref><ref name="pmid20495539">{{cite journal| author=Kitaya K, Yasuo T| title=Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. | journal=Mod Pathol | year= 2010 | volume= 23 | issue= 8 | pages= 1136-46 | pmid=20495539 | doi=10.1038/modpathol.2010.98 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20495539  }} </ref>
**The endometrial functional layer is the layer that sheds in [[menstruation]].
**These increased numbers of B-cells in the [[endometrial]] [[stroma]] invade into the gland lumina.
*Decreased [[CD16]]negative [[CD56]]positive/bright [[natural killer cells]] and increased [[T-cells]] in the [[secretory phase]] of the [[endometrium]].<ref name="pmid19341383">{{cite journal| author=Matteo M, Cicinelli E, Greco P, Massenzio F, Baldini D, Falagario T | display-authors=etal| title=Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis. | journal=Am J Reprod Immunol | year= 2009 | volume= 61 | issue= 5 | pages= 322-9 | pmid=19341383 | doi=10.1111/j.1600-0897.2009.00698.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19341383  }} </ref>
*Abnormal expression of some adhesion molecules and [[chemokines]] in the [[endometrial]] [[endothelial]] and [[epithelial cells]].<ref name="pmid20495539">{{cite journal| author=Kitaya K, Yasuo T| title=Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. | journal=Mod Pathol | year= 2010 | volume= 23 | issue= 8 | pages= 1136-46 | pmid=20495539 | doi=10.1038/modpathol.2010.98 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20495539  }} </ref>
**CD62E, [[CXCL1]], and [[CXCL13]] (these are involved in [[B-cell]] [[extravasation]] and migration).
*[[IL-6]] is increased in the [[menstrual]] flow.<ref name="pmid24314919">{{cite journal| author=Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C | display-authors=etal| title=Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 1 | pages= 242-7 | pmid=24314919 | doi=10.1016/j.fertnstert.2013.09.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24314919  }} </ref>
**[[IL-6]] is a differentiation factor of mature [[B-cells]].
*Increase in [[IL-1]]b and [[TNF-alpha|tumor necrosis factor (TNF)-a]].<ref name="pmid24314919">{{cite journal| author=Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C | display-authors=etal| title=Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 1 | pages= 242-7 | pmid=24314919 | doi=10.1016/j.fertnstert.2013.09.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24314919  }} </ref>
**[[TNF-alpha|TNF-a]] increases estrogen biosynthesis in the endometrial [[glandular]] cells. <ref name="pmid18957495">{{cite journal| author=Salama SA, Kamel MW, Diaz-Arrastia CR, Xu X, Veenstra TD, Salih S | display-authors=etal| title=Effect of tumor necrosis factor-alpha on estrogen metabolism and endometrial cells: potential physiological and pathological relevance. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 1 | pages= 285-93 | pmid=18957495 | doi=10.1210/jc.2008-1389 | pmc=2630861 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18957495  }} </ref>
***May be associated with [[endometrial]] micropolyposis which is seen in the [[hysteroscopy]] of patients with CE.<ref name="pmid22951914">{{cite journal| author=Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y| title=Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps. | journal=Hum Reprod | year= 2012 | volume= 27 | issue= 12 | pages= 3474-80 | pmid=22951914 | doi=10.1093/humrep/des323 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22951914  }} </ref><ref name="pmid15734762">{{cite journal| author=Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N| title=Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. | journal=Hum Reprod | year= 2005 | volume= 20 | issue= 5 | pages= 1386-9 | pmid=15734762 | doi=10.1093/humrep/deh779 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15734762  }} </ref>
*Increased [[immunoglobulin]] subclasses ([[IgM]], [[IgA]]1, [[IgA]]2, [[IgG]]1, and [[IgG]]2), especially IgG2.<ref name="pmid24898900">{{cite journal| author=Kitaya K, Tada Y, Hayashi T, Taguchi S, Funabiki M, Nakamura Y| title=Comprehensive endometrial immunoglobulin subclass analysis in infertile women suffering from repeated implantation failure with or without chronic endometritis. | journal=Am J Reprod Immunol | year= 2014 | volume= 72 | issue= 4 | pages= 386-91 | pmid=24898900 | doi=10.1111/aji.12277 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24898900  }} </ref>
**Negatively affect [[embryo]] [[implantation]].
**Rarely cause systemic [[inflammation]] or affect [[leukocyte]] counts, [[CRP]], or cause [[fever]].<ref name="pmid21749546">{{cite journal| author=Kitaya K, Yasuo T| title=Immunohistochemistrical and clinicopathological characterization of chronic endometritis. | journal=Am J Reprod Immunol | year= 2011 | volume= 66 | issue= 5 | pages= 410-5 | pmid=21749546 | doi=10.1111/j.1600-0897.2011.01051.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21749546  }} </ref><ref name="pmid26952510">{{cite journal| author=Kushnir VA, Solouki S, Sarig-Meth T, Vega MG, Albertini DF, Darmon SK | display-authors=etal| title=Systemic Inflammation and Autoimmunity in Women with Chronic Endometritis. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 6 | pages= 672-7 | pmid=26952510 | doi=10.1111/aji.12508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26952510  }} </ref>
*Delayed differentiation of [[endometrium]] in the mid-secretory phase.
**One-third of [[biopsies]] from [[infertile]] patients with CE have 'out-of-phase' [[morphology]].<ref name="pmid21749546">{{cite journal| author=Kitaya K, Yasuo T| title=Immunohistochemistrical and clinicopathological characterization of chronic endometritis. | journal=Am J Reprod Immunol | year= 2011 | volume= 66 | issue= 5 | pages= 410-5 | pmid=21749546 | doi=10.1111/j.1600-0897.2011.01051.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21749546  }} </ref>
**Pseudostratification and [[mitotic]] [[nuclei]] in the [[glandular]] and surface [[epithelial cells]].
*In the [[secretory phase]], the [[expression]] of the followings are upregulated:<ref name="pmid23351011">{{cite journal| author=Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA | display-authors=etal| title=Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. | journal=Am J Reprod Immunol | year= 2013 | volume= 69 | issue= 5 | pages= 509-17 | pmid=23351011 | doi=10.1111/aji.12076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23351011  }} </ref><ref name="pmid18686353">{{cite journal| author=Mishra K, Wadhwa N, Guleria K, Agarwal S| title=ER, PR and Ki-67 expression status in granulomatous and  chronic non-specific endometritis. | journal=J Obstet Gynaecol Res | year= 2008 | volume= 34 | issue= 3 | pages= 371-8 | pmid=18686353 | doi=10.1111/j.1447-0756.2007.00700.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18686353  }} </ref><ref name="pmid2114696">{{cite journal| author=Pickartz H, Beckmann R, Fleige B, Düe W, Gerdes J, Stein H| title=Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria. | journal=Virchows Arch A Pathol Anat Histopathol | year= 1990 | volume= 417 | issue= 2 | pages= 163-71 | pmid=2114696 | doi=10.1007/BF02190535 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2114696  }} </ref><ref name="pmid28259137">{{cite journal| author=Wu D, Kimura F, Zheng L, Ishida M, Niwa Y, Hirata K | display-authors=etal| title=Chronic endometritis modifies decidualization in human endometrial stromal cells. | journal=Reprod Biol Endocrinol | year= 2017 | volume= 15 | issue= 1 | pages= 16 | pmid=28259137 | doi=10.1186/s12958-017-0233-x | pmc=5336610 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28259137  }} </ref>
**Antiapoptotic [[genes]] (BCL2 and [[BAX]])
**Nuclear marker associated with [[proliferation]] ([[Ki-67]])
**[[Ovarian]] [[steroid]] receptors ([[estrogen receptor]]-a, and -b, [[progesterone receptor]]-A, and -B)
*The [[expression]] of the followings are downregulated:<ref name="pmid23351011">{{cite journal| author=Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA | display-authors=etal| title=Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. | journal=Am J Reprod Immunol | year= 2013 | volume= 69 | issue= 5 | pages= 509-17 | pmid=23351011 | doi=10.1111/aji.12076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23351011  }} </ref><ref name="pmid28259137">{{cite journal| author=Wu D, Kimura F, Zheng L, Ishida M, Niwa Y, Hirata K | display-authors=etal| title=Chronic endometritis modifies decidualization in human endometrial stromal cells. | journal=Reprod Biol Endocrinol | year= 2017 | volume= 15 | issue= 1 | pages= 16 | pmid=28259137 | doi=10.1186/s12958-017-0233-x | pmc=5336610 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28259137  }} </ref>
**[[Genes]]  associated with [[embryo]] receptivity (IL11, [[CCL4]], [[IGF1]], and [[CASP8]])
**[[Decidualization]] (PRL and [[IGFBP1]])


===Histopathology===
===Histopathology===
'''Acute Endometritis'''
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''Histopathology'''}} 
|-
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Acute Endometritis'''
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
|-
| style="padding: 5px 5px; background: #DCDCDC" |The [[histopathologic]] findings in [[acute]] endometritis include:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref>


The [[histopathologic]] findings in [[acute]] endometritis include:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref>
*Microabscess formation
* Microabscess formation
*[[Neutrophil]] invasion in:
* [[Neutrophil]] invasion in:
**[[Endometrial]] superficial [[epithelium]] and [[gland]] lumina
** [[Endometrial]] superficial [[epithelium]] and [[gland]] lumina
**[[Uterine]] cavity
** [[Uterine]] cavity
| style="padding: 5px 5px; background: #DCDCDC" |The [[histopathologic]] findings in [[chronic]] endometritis (CE) include:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref><ref name="pmid7254729">{{cite journal| author=Greenwood SM, Moran JJ| title=Chronic endometritis: morphologic and clinical observations. | journal=Obstet Gynecol | year= 1981 | volume= 58 | issue= 2 | pages= 176-84 | pmid=7254729 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7254729  }} </ref>
 
'''Chronic Endometritis'''


The [[histopathologic]] findings in [[chronic]] endometritis (CE) include:<ref name="pmid2137304">{{cite journal| author=Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA | display-authors=etal| title=Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. | journal=Am J Surg Pathol | year= 1990 | volume= 14 | issue= 2 | pages= 167-75 | pmid=2137304 | doi=10.1097/00000478-199002000-00008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2137304  }} </ref><ref name="pmid7254729">{{cite journal| author=Greenwood SM, Moran JJ| title=Chronic endometritis: morphologic and clinical observations. | journal=Obstet Gynecol | year= 1981 | volume= 58 | issue= 2 | pages= 176-84 | pmid=7254729 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7254729  }} </ref>
*Infiltration of plasmacytes in [[endometrial]] [[stroma]]
* Infiltration of plasmacytes in [[endometrial]] [[stroma]]
*Increase in [[stromal cell]] density
* Increase in [[stromal cell]] density
*Dissociated maturation between [[epithelium]] and [[stroma]]
* Dissociated maturation between [[epithelium]] and [[stroma]]
*[[Edema]] of [[endometrial]] superficial [[stroma]]
* [[Edema]] of [[endometrial]] superficial [[stroma]]
|}


[[Mycobacterium tuberculosis]] causes a subtype of [[chronic]] endometritis (CE) (chronic [[granulomatous]] endometritis) in some developing countries.  [[Histopathological|Histopathologically]], chronic [[granulomatous]] endometritis has [[caseating]] [[granuloma]] surrounded by infiltrates of lymphocytes which include endometrial [[stromal]] plasmacytes (ESPCs).<ref name="pmid18842939">{{cite journal| author=Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S | display-authors=etal| title=Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 12 | pages= 4068-70 | pmid=18842939 | doi=10.1128/JCM.01162-08 | pmc=2593260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18842939  }} </ref>
[[Mycobacterium tuberculosis]] causes a subtype of [[chronic]] endometritis (CE) (chronic [[granulomatous]] endometritis) in some developing countries.  [[Histopathological|Histopathologically]], chronic [[granulomatous]] endometritis has [[caseating]] [[granuloma]] surrounded by infiltrates of lymphocytes which include endometrial [[stromal]] plasmacytes (ESPCs).<ref name="pmid18842939">{{cite journal| author=Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S | display-authors=etal| title=Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 12 | pages= 4068-70 | pmid=18842939 | doi=10.1128/JCM.01162-08 | pmc=2593260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18842939  }} </ref>


==Causes==
==Causes==
'''Postpartum endometritis''' is caused by [[bacteria]] ascending from the lower [[genital]] tract into the [[cervix]] during labor. These bacteria that are the [[vaginal]] [[microflora]] include:<ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''Causes'''}} 
|-
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Postpartum Endometritis'''
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
|-
| style="padding: 5px 5px; background: #DCDCDC" |Postpartum endometritis is caused by [[bacteria]] ascending from the lower [[genital]] tract into the [[cervix]] during labor. These bacteria that are the [[vaginal]] [[microflora]] include:<ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>
 
*Alpha hemolytic [[streptococci]]
*[[Corynebacterium]]
*[[Diphtheroid|Diphtheroids]]
*[[E.coli]]
*[[Enterobacter]] agglomerans, E cloacae, E aerogenes
*[[Fusobacterium necrophorum]]
*[[Klebsiella pneumoniae]]
*[[Lactobacillus]] crispatus, L casei, L jansei
*[[Mycoplasma]] genitalia, M hominis
*Nondescript [[streptococci]]
*[[Prevotella]] bivia, P melaninogenicus
*[[Staphylococcus epidermidis]]
*[[Ureaplasma urealyticum]]


* Alpha hemolytic [[streptococci]]
| style="padding: 5px 5px; background: #DCDCDC" |The most common cause of [[chronic]] endometritis (CE) is an [[infection]] with [[microorganisms]], including:<ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref><ref name="pmid19521097">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Tinelli R, Saliani N, Resta L | display-authors=etal| title=Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. | journal=Gynecol Obstet Invest | year= 2009 | volume= 68 | issue= 2 | pages= 108-15 | pmid=19521097 | doi=10.1159/000223819 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19521097  }} </ref><ref name="pmid28608596">{{cite journal| author=Kitaya K, Matsubayashi H, Takaya Y, Nishiyama R, Yamaguchi K, Takeuchi T | display-authors=etal| title=Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. | journal=Am J Reprod Immunol | year= 2017 | volume= 78 | issue= 5 | pages=  | pmid=28608596 | doi=10.1111/aji.12719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28608596  }} </ref>
* [[Corynebacterium]]
* [[Diphtheroid|Diphtheroids]]
* [[E.coli]]
* [[Enterobacter]] agglomerans, E cloacae, E aerogenes
* [[Fusobacterium necrophorum]]
* [[Klebsiella pneumoniae]]
* [[Lactobacillus]] crispatus, L casei, L jansei
* [[Mycoplasma]] genitalia, M hominis
* Nondescript [[streptococci]]
* [[Prevotella]] bivia, P melaninogenicus
* [[Staphylococcus epidermidis]]
* [[Ureaplasma urealyticum]]


'''Acute endometritis''' is mostly caused by [[Chlamydia trachomatis]] and [[Neisseria gonorrhoeae]]<ref name="pmid21996319">{{cite journal| author=Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL | display-authors=etal| title=Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research. | journal=Pathol Res Pract | year= 2011 | volume= 207 | issue= 11 | pages= 680-5 | pmid=21996319 | doi=10.1016/j.prp.2011.08.007 | pmc=3215901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21996319 }} </ref>.
*[[Bacteria]]:
**[[Escherichia coli]]
**[[Streptococcus]] species
**[[Staphylococcus]] species
**[[Enterococcus faecalis]]
**[[Mycoplasma]] or [[ureaplasma]] species:
***[[Mycoplasma genitalium]]
***[[Mycoplasma hominis]]
***[[Ureaplasma urealyticum]]
**[[Proteus]] species
**[[Klebsiella pneumoniae]]
**[[Pseudomonas aeruginosa]]
**[[Gardnerella vaginalis]]
**[[Corynebacterium]]
*Yeasts:
**[[Candida]] species
**[[Saccharomyces cerevisiae]]
|}


The most common cause of '''[[chronic]] endometritis (CE)''' is an [[infection]] with [[microorganisms]], including:<ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref><ref name="pmid19521097">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Tinelli R, Saliani N, Resta L | display-authors=etal| title=Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. | journal=Gynecol Obstet Invest | year= 2009 | volume= 68 | issue= 2 | pages= 108-15 | pmid=19521097 | doi=10.1159/000223819 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19521097 }} </ref><ref name="pmid28608596">{{cite journal| author=Kitaya K, Matsubayashi H, Takaya Y, Nishiyama R, Yamaguchi K, Takeuchi T | display-authors=etal| title=Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. | journal=Am J Reprod Immunol | year= 2017 | volume= 78 | issue= 5 | pages= | pmid=28608596 | doi=10.1111/aji.12719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28608596 }} </ref>
'''Acute endometritis''' may be caused by [[Chlamydia trachomatis]] and [[Neisseria gonorrhea]].<ref name="pmid21996319">{{cite journal| author=Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL | display-authors=etal| title=Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research. | journal=Pathol Res Pract | year= 2011 | volume= 207 | issue= 11 | pages= 680-5 | pmid=21996319 | doi=10.1016/j.prp.2011.08.007 | pmc=3215901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21996319  }} </ref>
* [[Bacteria]]:
 
** [[Escherichia coli]]
The rate of infections with [[Chlamydia trachomatis]] (2%–7%) and [[Neisseria gonorrhea]] (0%–8%) in '''[[chronic]] endometritis (CE)''' are very low. <ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref><ref name="pmid15472851">{{cite journal| author=Haggerty CL, Hillier SL, Bass DC, Ness RB, PID Evaluation and Clinical Health study investigators| title=Bacterial vaginosis and anaerobic bacteria are associated with endometritis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 7 | pages= 990-5 | pmid=15472851 | doi=10.1086/423963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15472851 }} </ref><ref name="pmid12904693">{{cite journal| author=Polisseni F, Bambirra EA, Camargos AF| title=Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. | journal=Gynecol Obstet Invest | year= 2003 | volume= 55 | issue= 4 | pages= 205-10 | pmid=12904693 | doi=10.1159/000072075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12904693 }} </ref>
** [[Streptococcus]] species
** [[Staphylococcus]] species
** [[Enterococcus faecalis]]
** [[Mycoplasma]] or [[ureaplasma]] species:
*** [[Mycoplasma genitalium]]
*** [[Mycoplasma hominis]]
*** [[Ureaplasma urealyticum]]
** [[Proteus]]  species
** [[Klebsiella pneumoniae]]
** [[Pseudomonas aeruginosa]]
** [[Gardnerella vaginalis]]
** [[Corynebacterium]]
* Yeats:
** [[Candida]] species
** [[Saccharomyces cerevisiae]]


[[Mycobacterium tuberculosis]] causes a subtype of [[chronic]] endometritis (CE) (chronic [[granulomatous]] endometritis) in some developing countries.<ref name="pmid18842939">{{cite journal| author=Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S | display-authors=etal| title=Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 12 | pages= 4068-70 | pmid=18842939 | doi=10.1128/JCM.01162-08 | pmc=2593260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18842939  }} </ref>
[[Mycobacterium tuberculosis]] causes a subtype of [[chronic]] endometritis (CE) (chronic [[granulomatous]] endometritis) in some developing countries.<ref name="pmid18842939">{{cite journal| author=Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S | display-authors=etal| title=Association of tuberculous endometritis with infertility and other gynecological complaints of women in India. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 12 | pages= 4068-70 | pmid=18842939 | doi=10.1128/JCM.01162-08 | pmc=2593260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18842939  }} </ref>


The rate of infections with [[Chlamydia trachomatis]] (2%–7%) and [[Neisseria gonorrhea]] (0%–8%) in [[chronic]] endometritis (CE) are very low. <ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref><ref name="pmid15472851">{{cite journal| author=Haggerty CL, Hillier SL, Bass DC, Ness RB, PID Evaluation and Clinical Health study investigators| title=Bacterial vaginosis and anaerobic bacteria are associated with endometritis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 7 | pages= 990-5 | pmid=15472851 | doi=10.1086/423963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15472851  }} </ref><ref name="pmid12904693">{{cite journal| author=Polisseni F, Bambirra EA, Camargos AF| title=Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. | journal=Gynecol Obstet Invest | year= 2003 | volume= 55 | issue= 4 | pages= 205-10 | pmid=12904693 | doi=10.1159/000072075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12904693 }} </ref>
The association of viral infections as causes of '''[[chronic]] endometritis (CE)''' is still unclear.<ref name="pmid29960704">{{cite journal| author=Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T| title=Endometritis: new time, new concepts. | journal=Fertil Steril | year= 2018 | volume= 110 | issue= 3 | pages= 344-350 | pmid=29960704 | doi=10.1016/j.fertnstert.2018.04.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29960704 }} </ref>


The association of viral infections as causes of [[chronic]] endometritis (CE) is still unclear.<ref name="pmid29960704">{{cite journal| author=Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T| title=Endometritis: new time, new concepts. | journal=Fertil Steril | year= 2018 | volume= 110 | issue= 3 | pages= 344-350 | pmid=29960704 | doi=10.1016/j.fertnstert.2018.04.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29960704  }} </ref>
==Differentiating Endometritis from other Diseases==
'''Puerperal endometritis''' must be differentiated from:<ref name="Cunningham 2010 p.">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>


==Differentiating Endometritis  from other Diseases==
*[[Respiratory]] disorders
'''Puerperal endometritis''' must be differentiated from:<ref name="Cunningham 2010 p. ">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>
*[[Pyelonephritis]]
 
*[[Appendicitis]]
* [[Respiratory]] disorders
* [[Pyelonephritis]]
* [[Appendicitis]]


To view more differential diagnosis, [[Appendicitis differential diagnosis|click here]].
==Epidemiology==
==Epidemiology==
'''Puerperal Endometritis'''
'''Puerperal Endometritis'''


The [[prevalence]] of endometritis is 1% to 2% of births and 27% of cesarean births.<ref name="pmid15495005">{{cite journal| author=French LM, Smaill FM| title=Antibiotic regimens for endometritis after delivery. | journal=Cochrane Database Syst Rev | year= 2004 | volume=  | issue= 4 | pages= CD001067 | pmid=15495005 | doi=10.1002/14651858.CD001067.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495005  }} </ref><ref name="Sweet 2009 p. ">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref>
The [[prevalence]] of endometritis is 1% to 2% of births and 27% of cesarean births.<ref name="pmid15495005">{{cite journal| author=French LM, Smaill FM| title=Antibiotic regimens for endometritis after delivery. | journal=Cochrane Database Syst Rev | year= 2004 | volume=  | issue= 4 | pages= CD001067 | pmid=15495005 | doi=10.1002/14651858.CD001067.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495005  }} </ref><ref name="Sweet 2009 p.">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref>


'''Chronic Endometritis'''
'''Chronic Endometritis'''
Line 166: Line 181:


==Risk Factors==
==Risk Factors==
Risk factors associated with '''puerperal endometritis''' include:<ref name="pmid15495005">{{cite journal| author=French LM, Smaill FM| title=Antibiotic regimens for endometritis after delivery. | journal=Cochrane Database Syst Rev | year= 2004 | volume=  | issue= 4 | pages= CD001067 | pmid=15495005 | doi=10.1002/14651858.CD001067.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495005  }} </ref><ref name="Sweet 2009 p. ">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref><ref name="pmid19889389">{{cite journal| author=Belfort MA, Clark SL, Saade GR, Kleja K, Dildy GA, Van Veen TR | display-authors=etal| title=Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. | journal=Am J Obstet Gynecol | year= 2010 | volume= 202 | issue= 1 | pages= 35.e1-7 | pmid=19889389 | doi=10.1016/j.ajog.2009.08.029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19889389  }} </ref><ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''Risk Factors'''}} 
|-
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Puerperal Endometritis'''
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
|-
| style="padding: 5px 5px; background: #DCDCDC" |Risk factors associated with puerperal endometritis include:<ref name="pmid15495005">{{cite journal| author=French LM, Smaill FM| title=Antibiotic regimens for endometritis after delivery. | journal=Cochrane Database Syst Rev | year= 2004 | volume=  | issue= 4 | pages= CD001067 | pmid=15495005 | doi=10.1002/14651858.CD001067.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495005  }} </ref><ref name="Sweet 2009 p.">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref><ref name="pmid19889389">{{cite journal| author=Belfort MA, Clark SL, Saade GR, Kleja K, Dildy GA, Van Veen TR | display-authors=etal| title=Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. | journal=Am J Obstet Gynecol | year= 2010 | volume= 202 | issue= 1 | pages= 35.e1-7 | pmid=19889389 | doi=10.1016/j.ajog.2009.08.029 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19889389  }} </ref><ref name="pmid16085035">{{cite journal| author=Faro S| title=Postpartum endometritis. | journal=Clin Perinatol | year= 2005 | volume= 32 | issue= 3 | pages= 803-14 | pmid=16085035 | doi=10.1016/j.clp.2005.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16085035  }} </ref>


* [[Cesarean]] birth  
*[[Cesarean]] birth
* [[Surgical]] or instrumental birth  
*[[Surgical]] or instrumental birth
* [[Chorioamnionitis]]  
*[[Chorioamnionitis]]
* Prolonged rupture of membranes
*Prolonged rupture of membranes
* Retained [[placental]] fragments
*Retained [[placental]] fragments
* [[Postpartum hemorrhage]]
*[[Postpartum hemorrhage]]
* Frequent [[vaginal]] examinations
*Frequent [[vaginal]] examinations
* Colonization with [[group B Streptococcus]]
*Colonization with [[group B Streptococcus]]
| style="padding: 5px 5px; background: #DCDCDC" |[[Risk factors]] that have been reported to be associated with [[chronic]] endometritis (CE) include:<ref name="pmid21749546">{{cite journal| author=Kitaya K, Yasuo T| title=Immunohistochemistrical and clinicopathological characterization of chronic endometritis. | journal=Am J Reprod Immunol | year= 2011 | volume= 66 | issue= 5 | pages= 410-5 | pmid=21749546 | doi=10.1111/j.1600-0897.2011.01051.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21749546  }} </ref><ref name="pmid4984305">{{cite journal| author=Moyer DL, Mishell DR, Bell J| title=Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD. | journal=Am J Obstet Gynecol | year= 1970 | volume= 106 | issue= 6 | pages= 799-809 | pmid=4984305 | doi=10.1016/0002-9378(70)90470-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4984305  }} </ref><ref name="pmid19952932">{{cite journal| author=Smith M, Hagerty KA, Skipper B, Bocklage T| title=Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007. | journal=Int J Gynecol Pathol | year= 2010 | volume= 29 | issue= 1 | pages= 44-50 | pmid=19952932 | doi=10.1097/PGP.0b013e3181ae81bb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19952932  }} </ref><ref name="pmid27596852">{{cite journal| author=Chen YQ, Fang RL, Luo YN, Luo CQ| title=Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study. | journal=BMC Womens Health | year= 2016 | volume= 16 | issue= 1 | pages= 60 | pmid=27596852 | doi=10.1186/s12905-016-0341-3 | pmc=5477816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27596852  }} </ref><ref name="pmid28624114">{{cite journal| author=Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC | display-authors=etal| title=Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. | journal=Fertil Steril | year= 2017 | volume= 108 | issue= 2 | pages= 289-295.e1 | pmid=28624114 | doi=10.1016/j.fertnstert.2017.05.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28624114  }} </ref><ref name="pmid24558386">{{cite journal| author=Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A | display-authors=etal| title=The association between endometriosis and chronic endometritis. | journal=PLoS One | year= 2014 | volume= 9 | issue= 2 | pages= e88354 | pmid=24558386 | doi=10.1371/journal.pone.0088354 | pmc=3928198 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24558386  }} </ref><ref name="pmid7862377">{{cite journal| author=Korn AP, Bolan G, Padian N, Ohm-Smith M, Schachter J, Landers DV| title=Plasma cell endometritis in women with symptomatic bacterial vaginosis. | journal=Obstet Gynecol | year= 1995 | volume= 85 | issue= 3 | pages= 387-90 | pmid=7862377 | doi=10.1016/0029-7844(94)00400-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7862377  }} </ref><ref name="pmid9396917">{{cite journal| author=Peipert JF, Montagno AB, Cooper AS, Sung CJ| title=Bacterial vaginosis as a risk factor for upper genital tract infection. | journal=Am J Obstet Gynecol | year= 1997 | volume= 177 | issue= 5 | pages= 1184-7 | pmid=9396917 | doi=10.1016/s0002-9378(97)70038-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9396917  }} </ref><ref name="pmid22419745">{{cite journal| author=Jindal UN, Verma S, Bala Y| title=Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. | journal=Hum Reprod | year= 2012 | volume= 27 | issue= 5 | pages= 1368-74 | pmid=22419745 | doi=10.1093/humrep/des076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22419745  }} </ref><ref name="pmid6414236">{{cite journal| author=Degani S, Gonen R, de Vries K, Sharf M| title=Endometrial ossification associated with repeated abortions. | journal=Acta Obstet Gynecol Scand | year= 1983 | volume= 62 | issue= 3 | pages= 281-2 | pmid=6414236 | doi=10.3109/00016348309155810 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6414236  }} </ref>


[[Risk factors]] that have been reported to be associated with '''[[chronic]] endometritis (CE)''' include:<ref name="pmid21749546">{{cite journal| author=Kitaya K, Yasuo T| title=Immunohistochemistrical and clinicopathological characterization of chronic endometritis. | journal=Am J Reprod Immunol | year= 2011 | volume= 66 | issue= 5 | pages= 410-5 | pmid=21749546 | doi=10.1111/j.1600-0897.2011.01051.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21749546  }} </ref><ref name="pmid4984305">{{cite journal| author=Moyer DL, Mishell DR, Bell J| title=Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD. | journal=Am J Obstet Gynecol | year= 1970 | volume= 106 | issue= 6 | pages= 799-809 | pmid=4984305 | doi=10.1016/0002-9378(70)90470-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4984305  }} </ref><ref name="pmid19952932">{{cite journal| author=Smith M, Hagerty KA, Skipper B, Bocklage T| title=Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007. | journal=Int J Gynecol Pathol | year= 2010 | volume= 29 | issue= 1 | pages= 44-50 | pmid=19952932 | doi=10.1097/PGP.0b013e3181ae81bb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19952932  }} </ref><ref name="pmid27596852">{{cite journal| author=Chen YQ, Fang RL, Luo YN, Luo CQ| title=Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study. | journal=BMC Womens Health | year= 2016 | volume= 16 | issue= 1 | pages= 60 | pmid=27596852 | doi=10.1186/s12905-016-0341-3 | pmc=5477816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27596852  }} </ref><ref name="pmid28624114">{{cite journal| author=Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC | display-authors=etal| title=Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. | journal=Fertil Steril | year= 2017 | volume= 108 | issue= 2 | pages= 289-295.e1 | pmid=28624114 | doi=10.1016/j.fertnstert.2017.05.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28624114  }} </ref><ref name="pmid24558386">{{cite journal| author=Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A | display-authors=etal| title=The association between endometriosis and chronic endometritis. | journal=PLoS One | year= 2014 | volume= 9 | issue= 2 | pages= e88354 | pmid=24558386 | doi=10.1371/journal.pone.0088354 | pmc=3928198 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24558386  }} </ref><ref name="pmid7862377">{{cite journal| author=Korn AP, Bolan G, Padian N, Ohm-Smith M, Schachter J, Landers DV| title=Plasma cell endometritis in women with symptomatic bacterial vaginosis. | journal=Obstet Gynecol | year= 1995 | volume= 85 | issue= 3 | pages= 387-90 | pmid=7862377 | doi=10.1016/0029-7844(94)00400-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7862377  }} </ref><ref name="pmid9396917">{{cite journal| author=Peipert JF, Montagno AB, Cooper AS, Sung CJ| title=Bacterial vaginosis as a risk factor for upper genital tract infection. | journal=Am J Obstet Gynecol | year= 1997 | volume= 177 | issue= 5 | pages= 1184-7 | pmid=9396917 | doi=10.1016/s0002-9378(97)70038-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9396917  }} </ref><ref name="pmid22419745">{{cite journal| author=Jindal UN, Verma S, Bala Y| title=Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. | journal=Hum Reprod | year= 2012 | volume= 27 | issue= 5 | pages= 1368-74 | pmid=22419745 | doi=10.1093/humrep/des076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22419745  }} </ref><ref name="pmid6414236">{{cite journal| author=Degani S, Gonen R, de Vries K, Sharf M| title=Endometrial ossification associated with repeated abortions. | journal=Acta Obstet Gynecol Scand | year= 1983 | volume= 62 | issue= 3 | pages= 281-2 | pmid=6414236 | doi=10.3109/00016348309155810 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6414236  }} </ref>
*Intrauterine [[contraceptive]] devices (continuous use)
 
*Prolonged [[menstruation]]
* Intrauterine [[contraceptive]] devices (continuous use)
*Atypical [[uterine bleeding]]
* Prolonged [[menstruation]]
*[[Fallopian tube]] obstruction
* Atypical [[uterine bleeding]]
*Multiparity
* [[Fallopian tube]] obstruction
*[[Abortion]]
* Multiparity
*[[Bacterial vaginosis]]
* [[Abortion]]
*[[Endometrial hyperplasia]]
* [[Bacterial vaginosis]]
*Submucosal [[fibroids]]
* [[Endometrial hyperplasia]]
*[[Endometriosis]]
* Submucosal [[fibroids]]
*[[Endometrial]] osseous [[metaplasia]]
* [[Endometriosis]]
*[[Tuberculosis]]
* [[Endometrial]] osseous [[metaplasia]]
|}
* [[Tuberculosis]]


==Screening==
==Screening==
Line 200: Line 222:
===Natural History===
===Natural History===
Studies have suggested that patients with '''chronic endometritis (CE)''' may develop:<ref name="pmid26478517">{{cite journal| author=Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T | display-authors=etal| title=Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 1 | pages= 13-22 | pmid=26478517 | doi=10.1111/aji.12438 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26478517  }} </ref><ref name="pmid15482749">{{cite journal| author=Romero R, Espinoza J, Mazor M| title=Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? | journal=Fertil Steril | year= 2004 | volume= 82 | issue= 4 | pages= 799-804 | pmid=15482749 | doi=10.1016/j.fertnstert.2004.05.076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15482749  }} </ref><ref name="pmid21232841">{{cite journal| author=Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z| title=The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. | journal=Eur J Obstet Gynecol Reprod Biol | year= 2011 | volume= 155 | issue= 2 | pages= 217-20 | pmid=21232841 | doi=10.1016/j.ejogrb.2010.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232841  }} </ref>
Studies have suggested that patients with '''chronic endometritis (CE)''' may develop:<ref name="pmid26478517">{{cite journal| author=Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T | display-authors=etal| title=Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 1 | pages= 13-22 | pmid=26478517 | doi=10.1111/aji.12438 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26478517  }} </ref><ref name="pmid15482749">{{cite journal| author=Romero R, Espinoza J, Mazor M| title=Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? | journal=Fertil Steril | year= 2004 | volume= 82 | issue= 4 | pages= 799-804 | pmid=15482749 | doi=10.1016/j.fertnstert.2004.05.076 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15482749  }} </ref><ref name="pmid21232841">{{cite journal| author=Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z| title=The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. | journal=Eur J Obstet Gynecol Reprod Biol | year= 2011 | volume= 155 | issue= 2 | pages= 217-20 | pmid=21232841 | doi=10.1016/j.ejogrb.2010.12.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232841  }} </ref>
* [[Infertility]]
 
* Recurrent [[implantation]] failure (RIF)
*[[Infertility]]
* Recurrent [[pregnancy loss|pregnancy losses]] (RPLs)
*Recurrent [[implantation]] failure (RIF)
*Recurrent [[pregnancy loss|pregnancy losses]] (RPLs)
 
===Complications===
===Complications===
Complications of '''puerperal endometritis''' after [[cesarean]] birth may include:<ref name="Sweet 2009 p. ">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref><ref name="pmid23090454">{{cite journal| author=Soper DE| title=Early recognition of serious infections in obstetrics and gynecology. | journal=Clin Obstet Gynecol | year= 2012 | volume= 55 | issue= 4 | pages= 858-63 | pmid=23090454 | doi=10.1097/GRF.0b013e3182730f43 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23090454  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''Complications'''}} 
|-
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Puerperal Endometritis'''
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
|-
| style="padding: 5px 5px; background: #DCDCDC" |Complications of puerperal endometritis after [[cesarean]] birth may include:<ref name="Sweet 2009 p.">{{cite book | last=Sweet | first=Richard | title=Infectious diseases of the female genital tract | publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins | publication-place=Philadelphia | year=2009 | isbn=978-0-7817-7815-2 | oclc=268792315 | page=}}</ref><ref name="pmid23090454">{{cite journal| author=Soper DE| title=Early recognition of serious infections in obstetrics and gynecology. | journal=Clin Obstet Gynecol | year= 2012 | volume= 55 | issue= 4 | pages= 858-63 | pmid=23090454 | doi=10.1097/GRF.0b013e3182730f43 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23090454  }} </ref>


* [[Abscess]]
*[[Abscess]]
* [[Sepsis]]
*[[Sepsis]]
* [[Necrotizing fasciitis]]
*[[Necrotizing fasciitis]]
* [[Hematoma]]
*[[Hematoma]]
* Septic pelvic [[thrombophlebitis]]
*Septic pelvic [[thrombophlebitis]]
* [[Pneumonia]]  
*[[Pneumonia]]
* [[Pyelonephritis]]  
*[[Pyelonephritis]]
| style="padding: 5px 5px; background: #DCDCDC" |Common [[complications]] of chronic endometritis (CE) include:<ref name="pmid19217098">{{cite journal| author=Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA| title=Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. | journal=Fertil Steril | year= 2010 | volume= 93 | issue= 2 | pages= 437-41 | pmid=19217098 | doi=10.1016/j.fertnstert.2008.12.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19217098  }} </ref><ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref><ref name="pmid21030015">{{cite journal| author=Kitaya K| title=Prevalence of chronic endometritis in recurrent miscarriages. | journal=Fertil Steril | year= 2011 | volume= 95 | issue= 3 | pages= 1156-8 | pmid=21030015 | doi=10.1016/j.fertnstert.2010.09.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21030015  }} </ref><ref name="pmid26478517">{{cite journal| author=Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T | display-authors=etal| title=Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 1 | pages= 13-22 | pmid=26478517 | doi=10.1111/aji.12438 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26478517  }} </ref><ref name="pmid15901265">{{cite journal| author=Ghidini A, Salafia CM| title=Histologic placental lesions in women with recurrent preterm delivery. | journal=Acta Obstet Gynecol Scand | year= 2005 | volume= 84 | issue= 6 | pages= 547-50 | pmid=15901265 | doi=10.1111/j.0001-6349.2005.00694.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15901265  }} </ref>


Common [[complications]] of '''chronic endometritis (CE)''' include:<ref name="pmid19217098">{{cite journal| author=Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA| title=Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. | journal=Fertil Steril | year= 2010 | volume= 93 | issue= 2 | pages= 437-41 | pmid=19217098 | doi=10.1016/j.fertnstert.2008.12.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19217098  }} </ref><ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref><ref name="pmid21030015">{{cite journal| author=Kitaya K| title=Prevalence of chronic endometritis in recurrent miscarriages. | journal=Fertil Steril | year= 2011 | volume= 95 | issue= 3 | pages= 1156-8 | pmid=21030015 | doi=10.1016/j.fertnstert.2010.09.061 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21030015  }} </ref><ref name="pmid26478517">{{cite journal| author=Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T | display-authors=etal| title=Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. | journal=Am J Reprod Immunol | year= 2016 | volume= 75 | issue= 1 | pages= 13-22 | pmid=26478517 | doi=10.1111/aji.12438 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26478517  }} </ref><ref name="pmid15901265">{{cite journal| author=Ghidini A, Salafia CM| title=Histologic placental lesions in women with recurrent preterm delivery. | journal=Acta Obstet Gynecol Scand | year= 2005 | volume= 84 | issue= 6 | pages= 547-50 | pmid=15901265 | doi=10.1111/j.0001-6349.2005.00694.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15901265  }} </ref>
*[[Infertility]]
 
*Recurrent [[miscarriages]]
* [[Infertility]]
*Recurrent [[implantation]] failure following [[in vitro fertilization]] and embryo transfer (IVF-ET) treatment
* Recurrent [[miscarriages]]
*[[Obstetric]] complications
* Recurrent [[implantation]] failure following [[in vitro fertilization]] and embryo transfer (IVF-ET) treatment
*[[Neonatal]] complications
* [[Obstetric]] complications
*Chronic deciduitis
* [[Neonatal]] complications
|}
* Chronic deciduitis


===Prognosis===
===Prognosis===
Line 237: Line 268:


===History and  Symptoms===
===History and  Symptoms===
[[Symptoms]] of '''acute endometritis''' may include:<ref name="pmid7604765">{{cite journal| author=Michels TC| title=Chronic endometritis. | journal=Am Fam Physician | year= 1995 | volume= 52 | issue= 1 | pages= 217-22 | pmid=7604765 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7604765  }} </ref><ref name="King 2015 p. ">{{cite book | last=King | first=Tekoa | title=Varney's midwifery | publisher=Jones & Bartlett Learning | publication-place=Burlington, MA | year=2015 | isbn=978-1-284-02541-5 | oclc=855888968 | page=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
* [[Fever]]
|+
* [[Pelvic]] pain
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''History and  Symptoms'''}} 
* [[Vaginal discharge]]
|-
* [[Anorexia]]
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Acute Endometritis'''
* Chill
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
* [[Malaise]]
|-
| style="padding: 5px 5px; background: #DCDCDC" |[[Symptoms]] of acute endometritis may include:<ref name="pmid7604765">{{cite journal| author=Michels TC| title=Chronic endometritis. | journal=Am Fam Physician | year= 1995 | volume= 52 | issue= 1 | pages= 217-22 | pmid=7604765 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7604765  }} </ref><ref name="King 2015 p.">{{cite book | last=King | first=Tekoa | title=Varney's midwifery | publisher=Jones & Bartlett Learning | publication-place=Burlington, MA | year=2015 | isbn=978-1-284-02541-5 | oclc=855888968 | page=}}</ref>


'''[[Chronic]] endometritis (CE)''' is mostly [[asymptomatic]] but may have vague symptoms including:<ref name="pmid7604765">{{cite journal| author=Michels TC| title=Chronic endometritis. | journal=Am Fam Physician | year= 1995 | volume= 52 | issue= 1 | pages= 217-22 | pmid=7604765 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7604765  }} </ref><ref name="pmid748840">{{cite journal| author=Rotterdam H| title=Chronic endometritis. A clinicopathologic study. | journal=Pathol Annu | year= 1978 | volume= 13 Pt 2 | issue=  | pages= 209-31 | pmid=748840 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=748840  }} </ref><ref name="pmid9653909">{{cite journal| author=Yörükoğlu K, Kuyucouğlu F| title=Chronic nonspecific endometritis. | journal=Gen Diagn Pathol | year= 1998 | volume= 143 | issue= 5-6 | pages= 287-90 | pmid=9653909 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9653909  }} </ref>
*[[Fever]]
* [[Leucorrhea]]
*[[Pelvic]] pain
* Spotting/[[abnormal uterine bleeding]]
*[[Vaginal discharge]]
* [[Pelvic]] discomfort/pain
*[[Anorexia]]
* [[Dyspareunia]]
*Chill
*[[Malaise]]
| style="padding: 5px 5px; background: #DCDCDC" |[[Chronic]] endometritis (CE) is mostly [[asymptomatic]] but may have vague symptoms including:<ref name="pmid7604765">{{cite journal| author=Michels TC| title=Chronic endometritis. | journal=Am Fam Physician | year= 1995 | volume= 52 | issue= 1 | pages= 217-22 | pmid=7604765 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7604765  }} </ref><ref name="pmid748840">{{cite journal| author=Rotterdam H| title=Chronic endometritis. A clinicopathologic study. | journal=Pathol Annu | year= 1978 | volume= 13 Pt 2 | issue=  | pages= 209-31 | pmid=748840 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=748840  }} </ref><ref name="pmid9653909">{{cite journal| author=Yörükoğlu K, Kuyucouğlu F| title=Chronic nonspecific endometritis. | journal=Gen Diagn Pathol | year= 1998 | volume= 143 | issue= 5-6 | pages= 287-90 | pmid=9653909 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9653909  }} </ref>
 
*[[Leucorrhea]]
*Spotting/[[abnormal uterine bleeding]]
*[[Pelvic]] discomfort/pain
*[[Dyspareunia]]
|}


===Physical Examination===
===Physical Examination===
Clinical findings found on [[physical examination]] in '''puerperal endometritis''' may include:<ref name="King 2015 p. ">{{cite book | last=King | first=Tekoa | title=Varney's midwifery | publisher=Jones & Bartlett Learning | publication-place=Burlington, MA | year=2015 | isbn=978-1-284-02541-5 | oclc=855888968 | page=}}</ref>
Clinical findings found on [[physical examination]] in '''puerperal endometritis''' may include:<ref name="King 2015 p.">{{cite book | last=King | first=Tekoa | title=Varney's midwifery | publisher=Jones & Bartlett Learning | publication-place=Burlington, MA | year=2015 | isbn=978-1-284-02541-5 | oclc=855888968 | page=}}</ref>


* [[Fever]]
*[[Fever]]
* [[Tachycardia]]
*[[Tachycardia]]
* [[Uterine]] [[tenderness]]
*[[Uterine]] [[tenderness]]
* [[Pelvic]] pain on bimanual examination
*[[Pelvic]] pain on bimanual examination
* [[Lochia]]
*[[Lochia]]
* Subinvolution of [[uterus]]
*Subinvolution of [[uterus]]


===Laboratory Findings===
===Laboratory Findings===
Laboratory tests in '''puerperal endometritis''' include:<ref name="pmid17511893">{{cite journal| author=Maharaj D| title=Puerperal pyrexia: a review. Part I. | journal=Obstet Gynecol Surv | year= 2007 | volume= 62 | issue= 6 | pages= 393-9 | pmid=17511893 | doi=10.1097/01.ogx.0000265998.40912.5e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17511893  }} </ref><ref name="Cunningham 2010 p. ">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>
Laboratory tests in '''puerperal endometritis''' include:<ref name="pmid17511893">{{cite journal| author=Maharaj D| title=Puerperal pyrexia: a review. Part I. | journal=Obstet Gynecol Surv | year= 2007 | volume= 62 | issue= 6 | pages= 393-9 | pmid=17511893 | doi=10.1097/01.ogx.0000265998.40912.5e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17511893  }} </ref><ref name="Cunningham 2010 p.">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>


* [[Complete blood count]] with differential  
*[[Complete blood count]] with differential
* [[Metabolic]] panel
*[[Metabolic]] panel
* [[Urine culture]]
*[[Urine culture]]
* [[Blood culture]]  
*[[Blood culture]]


There is insufficient evidence that suggests obtaining endometrial or cervical cultures in '''puerperal endometritis''' due to contamination while obtaining an endometrial culture.<ref name="pmid24406036">{{cite journal| author=Karsnitz DB| title=Puerperal infections of the genital tract: a clinical review. | journal=J Midwifery Womens Health | year= 2013 | volume= 58 | issue= 6 | pages= 632-42 | pmid=24406036 | doi=10.1111/jmwh.12119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24406036  }} </ref><ref name="pmid17511894">{{cite journal| author=Maharaj D| title=Puerperal Pyrexia: a review. Part II. | journal=Obstet Gynecol Surv | year= 2007 | volume= 62 | issue= 6 | pages= 400-6 | pmid=17511894 | doi=10.1097/01.ogx.0000266063.84571.fb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17511894  }} </ref>  
There is insufficient evidence that suggests obtaining endometrial or cervical cultures in '''puerperal endometritis''' due to contamination while obtaining an endometrial culture.<ref name="pmid24406036">{{cite journal| author=Karsnitz DB| title=Puerperal infections of the genital tract: a clinical review. | journal=J Midwifery Womens Health | year= 2013 | volume= 58 | issue= 6 | pages= 632-42 | pmid=24406036 | doi=10.1111/jmwh.12119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24406036  }} </ref><ref name="pmid17511894">{{cite journal| author=Maharaj D| title=Puerperal Pyrexia: a review. Part II. | journal=Obstet Gynecol Surv | year= 2007 | volume= 62 | issue= 6 | pages= 400-6 | pmid=17511894 | doi=10.1097/01.ogx.0000266063.84571.fb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17511894  }} </ref>  


[[Laboratory]] findings in '''acute endometritis''' may include:<ref name="pmid30843321">{{cite journal| author=Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune A | display-authors=etal| title=Review: Chronic endometritis and its effect on reproduction. | journal=J Obstet Gynaecol Res | year= 2019 | volume= 45 | issue= 5 | pages= 951-960 | pmid=30843321 | doi=10.1111/jog.13937 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30843321  }} </ref>
[[Laboratory]] findings in '''acute endometritis''' may include:<ref name="pmid30843321">{{cite journal| author=Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune A | display-authors=etal| title=Review: Chronic endometritis and its effect on reproduction. | journal=J Obstet Gynaecol Res | year= 2019 | volume= 45 | issue= 5 | pages= 951-960 | pmid=30843321 | doi=10.1111/jog.13937 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30843321  }} </ref>
* [[Leukocytosis]]
 
* Elevated serum [[inflammatory]] markers
*[[Leukocytosis]]
*Elevated serum [[inflammatory]] markers


[[Staining]] used in  [[histological]] detection of '''chronic endometritis (CE)''' include:  
[[Staining]] used in  [[histological]] detection of '''chronic endometritis (CE)''' include:  
* [[Hematoxylin and eosin stain|Hematoxylin and eosin (H&E)]]<ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref><ref name="pmid22019126">{{cite journal| author=Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC | display-authors=etal| title=The impact of chronic endometritis on reproductive outcome. | journal=Fertil Steril | year= 2011 | volume= 96 | issue= 6 | pages= 1451-6 | pmid=22019126 | doi=10.1016/j.fertnstert.2011.09.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22019126  }} </ref>
 
* [[Immunohistochemical staining|Immunohistochemical (IHC) stain]] that detects [[CD38]] and [[CD138]] [[plasma cell]]-specific surface [[antigens]]:
*[[Hematoxylin and eosin stain|Hematoxylin and eosin (H&E)]]<ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref><ref name="pmid22019126">{{cite journal| author=Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC | display-authors=etal| title=The impact of chronic endometritis on reproductive outcome. | journal=Fertil Steril | year= 2011 | volume= 96 | issue= 6 | pages= 1451-6 | pmid=22019126 | doi=10.1016/j.fertnstert.2011.09.039 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22019126  }} </ref>
** Confirms the presence of [[plasma cells]] in the [[endometrium]].<ref name="pmid15335255">{{cite journal| author=Bayer-Garner IB, Nickell JA, Korourian S| title=Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis. | journal=Arch Pathol Lab Med | year= 2004 | volume= 128 | issue= 9 | pages= 1000-3 | pmid=15335255 | doi=10.1043/1543-2165(2004)128<1000:RSIAIT>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15335255  }} </ref>
*[[Immunohistochemical staining|Immunohistochemical (IHC) stain]] that detects [[CD38]] and [[CD138]] [[plasma cell]]-specific surface [[antigens]]:
** [[Immunohistochemical staining|IHC staining]] for [[CD138]] has higher sensitivity for diagnosing CE compared to [[H&E stain|H&E staining]] (56% vs. 13%).<ref name="pmid26207958">{{cite journal| author=McQueen DB, Perfetto CO, Hazard FK, Lathi RB| title=Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. | journal=Fertil Steril | year= 2015 | volume= 104 | issue= 4 | pages= 927-931 | pmid=26207958 | doi=10.1016/j.fertnstert.2015.06.044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26207958  }} </ref>
**Confirms the presence of [[plasma cells]] in the [[endometrium]].<ref name="pmid15335255">{{cite journal| author=Bayer-Garner IB, Nickell JA, Korourian S| title=Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis. | journal=Arch Pathol Lab Med | year= 2004 | volume= 128 | issue= 9 | pages= 1000-3 | pmid=15335255 | doi=10.1043/1543-2165(2004)128<1000:RSIAIT>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15335255  }} </ref>
**[[Immunohistochemical staining|IHC staining]] for [[CD138]] has higher sensitivity for diagnosing CE compared to [[H&E stain|H&E staining]] (56% vs. 13%).<ref name="pmid26207958">{{cite journal| author=McQueen DB, Perfetto CO, Hazard FK, Lathi RB| title=Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. | journal=Fertil Steril | year= 2015 | volume= 104 | issue= 4 | pages= 927-931 | pmid=26207958 | doi=10.1016/j.fertnstert.2015.06.044 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26207958  }} </ref>


===Electrocardiogram===
===Electrocardiogram===
Line 285: Line 327:


===X-ray===
===X-ray===
There are no [[x-ray]] findings associated with endometritis. However, a [[chest x-ray]] should be performed if there is suspicion of a [[respiratory]] disorder.<ref name="Cunningham 2010 p. ">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>
There are no [[x-ray]] findings associated with endometritis. However, a [[chest x-ray]] should be performed if there is suspicion of a [[respiratory]] disorder.<ref name="Cunningham 2010 p.">{{cite book | last=Cunningham | first=F | title=Williams obstetrics | publisher=McGraw-Hill Medical | publication-place=New York | year=2010 | isbn=978-0-07-149701-5 | oclc=495191519 | page=}}</ref>


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
Line 292: Line 334:
[[Ultrasound]] is usually not helpful in the [[diagnosis]] of endometritis. However, an [[ultrasound]] may be helpful to rule out other disorders in [[postpartum]] patients that are nonresponsive to therapy.<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref>
[[Ultrasound]] is usually not helpful in the [[diagnosis]] of endometritis. However, an [[ultrasound]] may be helpful to rule out other disorders in [[postpartum]] patients that are nonresponsive to therapy.<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref>
[[Ultrasound]] and [[CT]] findings in '''[[postpartum]] endometritis''' may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>  
[[Ultrasound]] and [[CT]] findings in '''[[postpartum]] endometritis''' may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>  
* Normal [[uterus]]
 
or
*Normal [[uterus]]
* Nonspecific findings due to retained products of [[conception]]:
*Nonspecific findings due to retained products of [[conception]]:
** Intrauterine fluid (with or without internal echoes due to [[blood]], [[gas]], or retained products of [[pregnancy]])
**Intrauterine fluid (with or without internal echoes due to [[blood]], [[gas]], or retained products of [[pregnancy]])
** Thickened heterogeneous [[endometrium]]
**Thickened heterogeneous [[endometrium]]


===CT scan===
===CT scan===
[[Ultrasound]] and [[CT]] findings in '''[[postpartum]] endometritis''' may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>   
[[Ultrasound]] and [[CT]] findings in '''[[postpartum]] endometritis''' may include:<ref name="pmid12719915">{{cite journal| author=Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA| title=CT of the acute abdomen: gynecologic etiologies. | journal=Abdom Imaging | year= 2003 | volume= 28 | issue= 3 | pages= 416-32 | pmid=12719915 | doi=10.1007/s00261-002-0052-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12719915  }} </ref><ref name="pmid1631288">{{cite journal| author=Langer JE, Dinsmore BJ| title=Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis. | journal=Radiol Clin North Am | year= 1992 | volume= 30 | issue= 4 | pages= 831-42 | pmid=1631288 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1631288  }} </ref><ref name="pmid10349536">{{cite journal| author=Urban BA, Pankov BL, Fishman EK| title=Postpartum complications in the abdomen and pelvis: CT evaluation. | journal=Crit Rev Diagn Imaging | year= 1999 | volume= 40 | issue= 1 | pages= 1-21 | pmid=10349536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10349536  }} </ref><ref name="pmid8356266">{{cite journal| author=Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP | display-authors=etal| title=Imaging of pregnancy-related complications. | journal=Radiographics | year= 1993 | volume= 13 | issue= 4 | pages= 753-70 | pmid=8356266 | doi=10.1148/radiographics.13.4.8356266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8356266  }} </ref><ref name="pmid9057511">{{cite journal| author=Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR | display-authors=etal| title=Imaging of pelvic postpartum complications. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 3 | pages= 663-8 | pmid=9057511 | doi=10.2214/ajr.168.3.9057511 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9057511  }} </ref>   
* Normal [[uterus]]
 
or
*Normal [[uterus]]
* Nonspecific findings due to retained products of [[conception]]:
*Nonspecific findings due to retained products of [[conception]]:
** Intrauterine fluid (with or without internal echoes due to [[blood]], [[gas]], or retained products of [[pregnancy]])
**Intrauterine fluid (with or without internal echoes due to [[blood]], [[gas]], or retained products of [[pregnancy]])
** Thickened heterogeneous [[endometrium]]
**Thickened heterogeneous [[endometrium]]


Compared to ultrasound, [[CT scan]] is more helpful in identifying the [[inflammation]] of the soft tissues and pelvic [[abscesses]].<ref name="pmid12110710">{{cite journal| author=Bennett GL, Slywotzky CM, Giovanniello G| title=Gynecologic causes of acute pelvic pain: spectrum of CT findings. | journal=Radiographics | year= 2002 | volume= 22 | issue= 4 | pages= 785-801 | pmid=12110710 | doi=10.1148/radiographics.22.4.g02jl18785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12110710  }} </ref>
Compared to ultrasound, [[CT scan]] is more helpful in identifying the [[inflammation]] of the soft tissues and pelvic [[abscesses]].<ref name="pmid12110710">{{cite journal| author=Bennett GL, Slywotzky CM, Giovanniello G| title=Gynecologic causes of acute pelvic pain: spectrum of CT findings. | journal=Radiographics | year= 2002 | volume= 22 | issue= 4 | pages= 785-801 | pmid=12110710 | doi=10.1148/radiographics.22.4.g02jl18785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12110710  }} </ref>
Line 313: Line 355:
===Other Imaging Findings===
===Other Imaging Findings===
Fluid [[hysteroscopy]] is helpful in diagnosing '''chronic endometritis (CE)''' and the findings include:<ref name="pmid15734762">{{cite journal| author=Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N| title=Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. | journal=Hum Reprod | year= 2005 | volume= 20 | issue= 5 | pages= 1386-9 | pmid=15734762 | doi=10.1093/humrep/deh779 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15734762  }} </ref><ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref>
Fluid [[hysteroscopy]] is helpful in diagnosing '''chronic endometritis (CE)''' and the findings include:<ref name="pmid15734762">{{cite journal| author=Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N| title=Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. | journal=Hum Reprod | year= 2005 | volume= 20 | issue= 5 | pages= 1386-9 | pmid=15734762 | doi=10.1093/humrep/deh779 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15734762  }} </ref><ref name="pmid17531993">{{cite journal| author=Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L | display-authors=etal| title=Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. | journal=Fertil Steril | year= 2008 | volume= 89 | issue= 3 | pages= 677-84 | pmid=17531993 | doi=10.1016/j.fertnstert.2007.03.074 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17531993  }} </ref>
* [[Edema]] of the [[stroma]]
 
* Micropolyps
*[[Edema]] of the [[stroma]]
* Focal or diffuse [[hyperemia]]
*Micropolyps
*Focal or diffuse [[hyperemia]]


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
Patients with '''postpartum endometritis''' are recommended to be treated with either:<ref name="pmid25751198">{{cite journal| author=Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ| title=Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review. | journal=Obstet Gynecol | year= 2015 | volume= 125 | issue= 4 | pages= 789-800 | pmid=25751198 | doi=10.1097/AOG.0000000000000732 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25751198  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
 
|+
* [[Clindamycin]] plus [[gentamicin]] (600 mg/every 6 h/[[oral]] or 4.5 g/every 24 h/IM)
! colspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#000|'''Histopathology'''}} 
* [[Amoxicillin clavulanate|Amoxicillin–clavulanic acid]] (875 mg/every 12 h /oral)
|-
* [[Cefotetan]] (2 g/every 8 h/IM)
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Postpartum Endometritis'''
* [[Meropenem]] or [[imipenem]]–[[cilastatin]] (500 mg/every 8 h/IM)
| style="padding: 5px 5px; background: #4479BA;" align="center" |'''Chronic Endometritis'''
* [[Amoxicillin]] plus [[metronidazole]] (500 mg/every 8 h/[[oral]])
|-
| style="padding: 5px 5px; background: #DCDCDC" |Patients with postpartum endometritis are recommended to be treated with either:<ref name="pmid25751198">{{cite journal| author=Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ| title=Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review. | journal=Obstet Gynecol | year= 2015 | volume= 125 | issue= 4 | pages= 789-800 | pmid=25751198 | doi=10.1097/AOG.0000000000000732 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25751198  }} </ref>


Patients with '''chronic endometritis (CE)''' are treated with:  
*[[Clindamycin]] plus [[gentamicin]] (600 mg/every 6 h/[[oral]] or 4.5 g/every 24 h/IM)
* First-line therapy:
*[[Amoxicillin clavulanate|Amoxicillin–clavulanic acid]] (875 mg/every 12 h /oral)
** [[Doxycycline]] 100 mg/twice per day/14 days<ref name="pmid19217098">{{cite journal| author=Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA| title=Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. | journal=Fertil Steril | year= 2010 | volume= 93 | issue= 2 | pages= 437-41 | pmid=19217098 | doi=10.1016/j.fertnstert.2008.12.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19217098  }} </ref>
*[[Cefotetan]] (2 g/every 8 h/IM)
* Second-line therapy:
*[[Meropenem]] or [[imipenem]]–[[cilastatin]] (500 mg/every 8 h/IM)
** Combination of [[ofloxacin]]/400 mg/twice per day/14 days and [[metronidazole]]/500 mg/twice per day /14 days<ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref>
*[[Amoxicillin]] plus [[metronidazole]] (500 mg/every 8 h/[[oral]])
| style="padding: 5px 5px; background: #DCDCDC" |Patients with chronic endometritis (CE) are treated with:
 
*First-line therapy:
**[[Doxycycline]] 100 mg/twice per day/14 days<ref name="pmid19217098">{{cite journal| author=Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA| title=Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. | journal=Fertil Steril | year= 2010 | volume= 93 | issue= 2 | pages= 437-41 | pmid=19217098 | doi=10.1016/j.fertnstert.2008.12.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19217098  }} </ref>
*Second-line therapy:
**Combination of [[ofloxacin]]/400 mg/twice per day/14 days and [[metronidazole]]/500 mg/twice per day /14 days<ref name="pmid24462055">{{cite journal| author=McQueen DB, Bernardi LA, Stephenson MD| title=Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. | journal=Fertil Steril | year= 2014 | volume= 101 | issue= 4 | pages= 1026-30 | pmid=24462055 | doi=10.1016/j.fertnstert.2013.12.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24462055  }} </ref>
|}


===Surgery===
===Surgery===
Line 344: Line 395:
  | year= 2006 | volume=  | issue=  | pages=  | pmid=21834192 | doi= | pmc= | url= }} </ref>
  | year= 2006 | volume=  | issue=  | pages=  | pmid=21834192 | doi= | pmc= | url= }} </ref>


* Routine [[antepartum]] screening and treatment of [[GBS]] and [[infections]]  
*Routine [[antepartum]] screening and treatment of [[GBS]] and [[infections]]
* [[Handwashing]]
*[[Handwashing]]
* [[Aseptic]] procedure
*[[Aseptic]] procedure
* Decrease in [[vaginal]] examinations
*Decrease in [[vaginal]] examinations
* Limiting use of invasive procedures
*Limiting use of invasive procedures
* Limiting [[Episiotomy|episiotomies]]
*Limiting [[Episiotomy|episiotomies]]
* Synthetic [[suture]] use
*Synthetic [[suture]] use
* Decrease in [[cesarean]] births
*Decrease in [[cesarean]] births
* Rapid repair of [[lacerations]]
*Rapid repair of [[lacerations]]
* Standard [[suture]] techniques
*Standard [[suture]] techniques
* [[Prophylaxis]] with [[antibiotics]] in [[anal sphincter]] injuries
*[[Prophylaxis]] with [[antibiotics]] in [[anal sphincter]] injuries


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of endometritis.
There are no established measures for the secondary prevention of endometritis.


== References ==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Obstetrics]]
[[Category:Inflammations]]
[[Category:Up To Date]]

Latest revision as of 15:53, 11 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords: acute endometritis, chronic endometritis, postpartum endometritis, puerperal endometritis

Overview

Endometritis is classified histopathologically into two subtypes: acute endometritis and chronic endometritis (CE). Acute endometritis occurs following abortion, childbirth, menstruation, curettage, or IUD insertion. Symptoms of acute endometritis may include fever, pelvic pain, and vaginal discharge. On histopathology, many neutrophils are seen in the endometrial stroma in acute endometritis. Chronic endometritis may cause infertility. Chronic endometritis (CE) is mostly asymptomatic but may have vague symptoms. On histopathology, plasma cells are seen in the endometrial stroma in chronic endometritis (CE). Endometritis is mostly caused by infection and treated with antibiotics. Pyometra is a rare disorder with pus accumulation in the uterine cavity due to abnormal drainage of the uterus.

Historical Perspective

There is limited information on the historical perspective of endometritis.

Classification

Endometritis may be classified according to histopathology into two subtypes:[1]

Pyometra

Pathophysiology

Postpartum endometritis

Postpartum endometritis is caused by bacteria (vaginal microflora) ascending from the lower genital tract during labor.[9]

Artificial or spontaneous rupture of membranes may also happen without bacterial colonization.[9]

Chronic Endometritis

In the normal endometrium, B-cells are mostly seen in the basal layer.[10]

In chronic endometritis (CE):[11]

Histopathology

Histopathology 
Acute Endometritis Chronic Endometritis
The histopathologic findings in acute endometritis include:[1] The histopathologic findings in chronic endometritis (CE) include:[1][26]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries. Histopathologically, chronic granulomatous endometritis has caseating granuloma surrounded by infiltrates of lymphocytes which include endometrial stromal plasmacytes (ESPCs).[4]

Causes

Causes 
Postpartum Endometritis Chronic Endometritis
Postpartum endometritis is caused by bacteria ascending from the lower genital tract into the cervix during labor. These bacteria that are the vaginal microflora include:[9] The most common cause of chronic endometritis (CE) is an infection with microorganisms, including:[27][28][29]

Acute endometritis may be caused by Chlamydia trachomatis and Neisseria gonorrhea.[30]

The rate of infections with Chlamydia trachomatis (2%–7%) and Neisseria gonorrhea (0%–8%) in chronic endometritis (CE) are very low. [27][31][32]

Mycobacterium tuberculosis causes a subtype of chronic endometritis (CE) (chronic granulomatous endometritis) in some developing countries.[4]

The association of viral infections as causes of chronic endometritis (CE) is still unclear.[11]

Differentiating Endometritis from other Diseases

Puerperal endometritis must be differentiated from:[3]

To view more differential diagnosis, click here.

Epidemiology

Puerperal Endometritis

The prevalence of endometritis is 1% to 2% of births and 27% of cesarean births.[33][34]

Chronic Endometritis

The prevalence of chronic endometritis (CE) is about 10% to 11% on biopsies performed from hysterectomies of patients with gynecologic conditions.[20][32]

In a study, the prevalence of CE has been reported to be 15% in infertile women with in vitro fertilization (IVF) and 42% in women with recurrent implantation failure (RIF).[35]

The prevalence of CE has been reported to be 57.8% in women with three or more recurrent pregnancy losses (RPLs).[36]

In one study, the prevalence of CE has been reported to be 14% and 27% in patients with RIF or RPL, respectively.[37]

Risk Factors

Risk Factors 
Puerperal Endometritis Chronic Endometritis
Risk factors associated with puerperal endometritis include:[33][34][38][9] Risk factors that have been reported to be associated with chronic endometritis (CE) include:[20][39][40][41][42][43][44][45][46][47]

Screening

Routine antepartum screening for GBS infection and treatment of genital tract infections are important in preventing puerperal genital tract infection.[48]

There is insufficient evidence to recommend routine screening for chronic endometritis (CE). However, it has been suggested that hysteroscopy may have the potential to be a screening tool for CE.[11]

Natural History, Complications, and Prognosis

Natural History

Studies have suggested that patients with chronic endometritis (CE) may develop:[49][35][36]

Complications

Complications 
Puerperal Endometritis Chronic Endometritis
Complications of puerperal endometritis after cesarean birth may include:[34][50] Common complications of chronic endometritis (CE) include:[51][52][53][49][54]

Prognosis

A study showed that after antibiotic treatment of patients with CE and recurrent pregnancy losses (RPLs), the pre-pregnancy live birth rate increased from 7% (before treatment) to 56% (after treatment).[52]

Another study showed that after antibiotic treatment of patients with CE, the implantation rate and pregnancy rate increased from 4.9% and 7.4% (before treatment) to 18.6% and 29.3% (after treatment), respectively.[55]

Diagnosis

Diagnostic Study of Choice

The histological finding of acute endometritis includes a large number of neutrophils in the endometrial stroma.[56]

The diagnosis of chronic endometritis (CE) is made with endometrial biopsy and the histological diagnostic criterion is plasma cells in the endometrial stroma.[20][57]

History and Symptoms

History and Symptoms 
Acute Endometritis Chronic Endometritis
Symptoms of acute endometritis may include:[58][59] Chronic endometritis (CE) is mostly asymptomatic but may have vague symptoms including:[58][60][61]

Physical Examination

Clinical findings found on physical examination in puerperal endometritis may include:[59]

Laboratory Findings

Laboratory tests in puerperal endometritis include:[48][3]

There is insufficient evidence that suggests obtaining endometrial or cervical cultures in puerperal endometritis due to contamination while obtaining an endometrial culture.[62][63]

Laboratory findings in acute endometritis may include:[64]

Staining used in histological detection of chronic endometritis (CE) include:

Electrocardiogram

There are no ECG findings associated with endometritis.

X-ray

There are no x-ray findings associated with endometritis. However, a chest x-ray should be performed if there is suspicion of a respiratory disorder.[3]

Echocardiography or Ultrasound

There are no echocardiography findings associated with endometritis.

Ultrasound is usually not helpful in the diagnosis of endometritis. However, an ultrasound may be helpful to rule out other disorders in postpartum patients that are nonresponsive to therapy.[67] Ultrasound and CT findings in postpartum endometritis may include:[67][68][69][70][71]

CT scan

Ultrasound and CT findings in postpartum endometritis may include:[67][68][69][70][71]

Compared to ultrasound, CT scan is more helpful in identifying the inflammation of the soft tissues and pelvic abscesses.[72]

MRI

There are no specific MRI findings associated with endometritis. However, MRI may be helpful if there is suspicion of septic pelvic thrombophlebitis.[62]

Other Imaging Findings

Fluid hysteroscopy is helpful in diagnosing chronic endometritis (CE) and the findings include:[18][27]

Treatment

Medical Therapy

Histopathology 
Postpartum Endometritis Chronic Endometritis
Patients with postpartum endometritis are recommended to be treated with either:[73] Patients with chronic endometritis (CE) are treated with:

Surgery

Surgery may be indicated if there is drainable fluid collection due to infection.[62]

Primary Prevention

The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) recommend antimicrobial prophylaxis 60 minutes prior to incision of cesarean birth.[74][75][76]

A Conchrane study showed that antimicrobial prophylaxis decreases uterine and wound infections.[75]

Some of the measures that should be considered in order to reduce genital tract infections include:[48][75][77][78]

Secondary Prevention

There are no established measures for the secondary prevention of endometritis.

References

  1. ↑ 1.0 1.1 1.2 Kiviat NB, Wølner-Hanssen P, Eschenbach DA, Wasserheit JN, Paavonen JA, Bell TA; et al. (1990). "Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis". Am J Surg Pathol. 14 (2): 167–75. doi:10.1097/00000478-199002000-00008. PMID 2137304.
  2. ↑ Hellweg, G (2010). Atlas of endometrial histopathology. Heidelberg: Springer. ISBN 978-3-642-01541-0. OCLC 663096526.
  3. ↑ 3.0 3.1 3.2 3.3 Cunningham, F (2010). Williams obstetrics. New York: McGraw-Hill Medical. ISBN 978-0-07-149701-5. OCLC 495191519.
  4. ↑ 4.0 4.1 4.2 Kumar P, Shah NP, Singhal A, Chauhan DS, Katoch VM, Mittal S; et al. (2008). "Association of tuberculous endometritis with infertility and other gynecological complaints of women in India". J Clin Microbiol. 46 (12): 4068–70. doi:10.1128/JCM.01162-08. PMC 2593260. PMID 18842939.
  5. ↑ Muram D, Drouin P, Thompson FE, Oxorn H (1981). "Pyometra". Can Med Assoc J. 125 (6): 589–92. PMC 1862642. PMID 7284938.
  6. ↑ Yamada T, Ando N, Shibata N, Suitou M, Takagi H, Matsunami K; et al. (2015). "Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin". Case Rep Surg. 2015: 548481. doi:10.1155/2015/548481. PMC 4299690. PMID 25628913.
  7. ↑ 7.0 7.1 7.2 7.3 Yildizhan B, Uyar E, Sişmanoğlu A, Güllüoğlu G, Kavak ZN (2006). "Spontaneous perforation of pyometra". Infect Dis Obstet Gynecol. 2006: 26786. doi:10.1155/IDOG/2006/26786. PMC 1581463. PMID 17093350.
  8. ↑ Shapey IM, Nasser T, Dickens P, Haldar M, Solkar MH (2012). "Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum". Ann R Coll Surg Engl. 94 (8): e246–8. doi:10.1308/003588412X13373405387410. PMC 3954306. PMID 23131215.
  9. ↑ 9.0 9.1 9.2 9.3 Faro S (2005). "Postpartum endometritis". Clin Perinatol. 32 (3): 803–14. doi:10.1016/j.clp.2005.04.005. PMID 16085035.
  10. ↑ Yeaman GR, Guyre PM, Fanger MW, Collins JE, White HD, Rathbun W; et al. (1997). "Unique CD8+ T cell-rich lymphoid aggregates in human uterine endometrium". J Leukoc Biol. 61 (4): 427–35. PMID 9103229.
  11. ↑ 11.0 11.1 11.2 Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T (2018). "Endometritis: new time, new concepts". Fertil Steril. 110 (3): 344–350. doi:10.1016/j.fertnstert.2018.04.012. PMID 29960704.
  12. ↑ Tabibzadeh SS, Bettica A, Gerber MA (1986). "Variable expression of Ia antigens in human endometrium and in chronic endometritis". Am J Clin Pathol. 86 (2): 153–60. doi:10.1093/ajcp/86.2.153. PMID 3461701.
  13. ↑ 13.0 13.1 Kitaya K, Yasuo T (2010). "Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis". Mod Pathol. 23 (8): 1136–46. doi:10.1038/modpathol.2010.98. PMID 20495539.
  14. ↑ Matteo M, Cicinelli E, Greco P, Massenzio F, Baldini D, Falagario T; et al. (2009). "Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis". Am J Reprod Immunol. 61 (5): 322–9. doi:10.1111/j.1600-0897.2009.00698.x. PMID 19341383.
  15. ↑ 15.0 15.1 Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C; et al. (2014). "Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis". Fertil Steril. 101 (1): 242–7. doi:10.1016/j.fertnstert.2013.09.041. PMID 24314919.
  16. ↑ Salama SA, Kamel MW, Diaz-Arrastia CR, Xu X, Veenstra TD, Salih S; et al. (2009). "Effect of tumor necrosis factor-alpha on estrogen metabolism and endometrial cells: potential physiological and pathological relevance". J Clin Endocrinol Metab. 94 (1): 285–93. doi:10.1210/jc.2008-1389. PMC 2630861. PMID 18957495.
  17. ↑ Kitaya K, Tada Y, Taguchi S, Funabiki M, Hayashi T, Nakamura Y (2012). "Local mononuclear cell infiltrates in infertile patients with endometrial macropolyps versus micropolyps". Hum Reprod. 27 (12): 3474–80. doi:10.1093/humrep/des323. PMID 22951914.
  18. ↑ 18.0 18.1 Cicinelli E, Resta L, Nicoletti R, Zappimbulso V, Tartagni M, Saliani N (2005). "Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis". Hum Reprod. 20 (5): 1386–9. doi:10.1093/humrep/deh779. PMID 15734762.
  19. ↑ Kitaya K, Tada Y, Hayashi T, Taguchi S, Funabiki M, Nakamura Y (2014). "Comprehensive endometrial immunoglobulin subclass analysis in infertile women suffering from repeated implantation failure with or without chronic endometritis". Am J Reprod Immunol. 72 (4): 386–91. doi:10.1111/aji.12277. PMID 24898900.
  20. ↑ 20.0 20.1 20.2 20.3 20.4 Kitaya K, Yasuo T (2011). "Immunohistochemistrical and clinicopathological characterization of chronic endometritis". Am J Reprod Immunol. 66 (5): 410–5. doi:10.1111/j.1600-0897.2011.01051.x. PMID 21749546.
  21. ↑ Kushnir VA, Solouki S, Sarig-Meth T, Vega MG, Albertini DF, Darmon SK; et al. (2016). "Systemic Inflammation and Autoimmunity in Women with Chronic Endometritis". Am J Reprod Immunol. 75 (6): 672–7. doi:10.1111/aji.12508. PMID 26952510.
  22. ↑ 22.0 22.1 Di Pietro C, Cicinelli E, Guglielmino MR, Ragusa M, Farina M, Palumbo MA; et al. (2013). "Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis". Am J Reprod Immunol. 69 (5): 509–17. doi:10.1111/aji.12076. PMID 23351011.
  23. ↑ Mishra K, Wadhwa N, Guleria K, Agarwal S (2008). "ER, PR and Ki-67 expression status in granulomatous and chronic non-specific endometritis". J Obstet Gynaecol Res. 34 (3): 371–8. doi:10.1111/j.1447-0756.2007.00700.x. PMID 18686353.
  24. ↑ Pickartz H, Beckmann R, Fleige B, Düe W, Gerdes J, Stein H (1990). "Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria". Virchows Arch A Pathol Anat Histopathol. 417 (2): 163–71. doi:10.1007/BF02190535. PMID 2114696.
  25. ↑ 25.0 25.1 Wu D, Kimura F, Zheng L, Ishida M, Niwa Y, Hirata K; et al. (2017). "Chronic endometritis modifies decidualization in human endometrial stromal cells". Reprod Biol Endocrinol. 15 (1): 16. doi:10.1186/s12958-017-0233-x. PMC 5336610. PMID 28259137.
  26. ↑ Greenwood SM, Moran JJ (1981). "Chronic endometritis: morphologic and clinical observations". Obstet Gynecol. 58 (2): 176–84. PMID 7254729.
  27. ↑ 27.0 27.1 27.2 Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L; et al. (2008). "Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies". Fertil Steril. 89 (3): 677–84. doi:10.1016/j.fertnstert.2007.03.074. PMID 17531993.
  28. ↑ Cicinelli E, De Ziegler D, Nicoletti R, Tinelli R, Saliani N, Resta L; et al. (2009). "Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis". Gynecol Obstet Invest. 68 (2): 108–15. doi:10.1159/000223819. PMID 19521097.
  29. ↑ Kitaya K, Matsubayashi H, Takaya Y, Nishiyama R, Yamaguchi K, Takeuchi T; et al. (2017). "Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure". Am J Reprod Immunol. 78 (5). doi:10.1111/aji.12719. PMID 28608596.
  30. ↑ Vicetti Miguel RD, Chivukula M, Krishnamurti U, Amortegui AJ, Kant JA, Sweet RL; et al. (2011). "Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research". Pathol Res Pract. 207 (11): 680–5. doi:10.1016/j.prp.2011.08.007. PMC 3215901. PMID 21996319.
  31. ↑ Haggerty CL, Hillier SL, Bass DC, Ness RB, PID Evaluation and Clinical Health study investigators (2004). "Bacterial vaginosis and anaerobic bacteria are associated with endometritis". Clin Infect Dis. 39 (7): 990–5. doi:10.1086/423963. PMID 15472851.
  32. ↑ 32.0 32.1 Polisseni F, Bambirra EA, Camargos AF (2003). "Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients". Gynecol Obstet Invest. 55 (4): 205–10. doi:10.1159/000072075. PMID 12904693.
  33. ↑ 33.0 33.1 French LM, Smaill FM (2004). "Antibiotic regimens for endometritis after delivery". Cochrane Database Syst Rev (4): CD001067. doi:10.1002/14651858.CD001067.pub2. PMID 15495005.
  34. ↑ 34.0 34.1 34.2 Sweet, Richard (2009). Infectious diseases of the female genital tract. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0-7817-7815-2. OCLC 268792315.
  35. ↑ 35.0 35.1 Romero R, Espinoza J, Mazor M (2004). "Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization?". Fertil Steril. 82 (4): 799–804. doi:10.1016/j.fertnstert.2004.05.076. PMID 15482749.
  36. ↑ 36.0 36.1 Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z (2011). "The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion". Eur J Obstet Gynecol Reprod Biol. 155 (2): 217–20. doi:10.1016/j.ejogrb.2010.12.010. PMID 21232841.
  37. ↑ Bouet PE, El Hachem H, Monceau E, Gariépy G, Kadoch IJ, Sylvestre C (2016). "Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis". Fertil Steril. 105 (1): 106–10. doi:10.1016/j.fertnstert.2015.09.025. PMID 26456229.
  38. ↑ Belfort MA, Clark SL, Saade GR, Kleja K, Dildy GA, Van Veen TR; et al. (2010). "Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period". Am J Obstet Gynecol. 202 (1): 35.e1–7. doi:10.1016/j.ajog.2009.08.029. PMID 19889389.
  39. ↑ Moyer DL, Mishell DR, Bell J (1970). "Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD". Am J Obstet Gynecol. 106 (6): 799–809. doi:10.1016/0002-9378(70)90470-9. PMID 4984305.
  40. ↑ Smith M, Hagerty KA, Skipper B, Bocklage T (2010). "Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007". Int J Gynecol Pathol. 29 (1): 44–50. doi:10.1097/PGP.0b013e3181ae81bb. PMID 19952932.
  41. ↑ Chen YQ, Fang RL, Luo YN, Luo CQ (2016). "Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study". BMC Womens Health. 16 (1): 60. doi:10.1186/s12905-016-0341-3. PMC 5477816. PMID 27596852.
  42. ↑ Cicinelli E, Trojano G, Mastromauro M, Vimercati A, Marinaccio M, Mitola PC; et al. (2017). "Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link". Fertil Steril. 108 (2): 289–295.e1. doi:10.1016/j.fertnstert.2017.05.016. PMID 28624114.
  43. ↑ Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A; et al. (2014). "The association between endometriosis and chronic endometritis". PLoS One. 9 (2): e88354. doi:10.1371/journal.pone.0088354. PMC 3928198. PMID 24558386.
  44. ↑ Korn AP, Bolan G, Padian N, Ohm-Smith M, Schachter J, Landers DV (1995). "Plasma cell endometritis in women with symptomatic bacterial vaginosis". Obstet Gynecol. 85 (3): 387–90. doi:10.1016/0029-7844(94)00400-8. PMID 7862377.
  45. ↑ Peipert JF, Montagno AB, Cooper AS, Sung CJ (1997). "Bacterial vaginosis as a risk factor for upper genital tract infection". Am J Obstet Gynecol. 177 (5): 1184–7. doi:10.1016/s0002-9378(97)70038-3. PMID 9396917.
  46. ↑ Jindal UN, Verma S, Bala Y (2012). "Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis". Hum Reprod. 27 (5): 1368–74. doi:10.1093/humrep/des076. PMID 22419745.
  47. ↑ Degani S, Gonen R, de Vries K, Sharf M (1983). "Endometrial ossification associated with repeated abortions". Acta Obstet Gynecol Scand. 62 (3): 281–2. doi:10.3109/00016348309155810. PMID 6414236.
  48. ↑ 48.0 48.1 48.2 Maharaj D (2007). "Puerperal pyrexia: a review. Part I." Obstet Gynecol Surv. 62 (6): 393–9. doi:10.1097/01.ogx.0000265998.40912.5e. PMID 17511893.
  49. ↑ 49.0 49.1 Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T; et al. (2016). "Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications". Am J Reprod Immunol. 75 (1): 13–22. doi:10.1111/aji.12438. PMID 26478517.
  50. ↑ Soper DE (2012). "Early recognition of serious infections in obstetrics and gynecology". Clin Obstet Gynecol. 55 (4): 858–63. doi:10.1097/GRF.0b013e3182730f43. PMID 23090454.
  51. ↑ 51.0 51.1 Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA (2010). "Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization". Fertil Steril. 93 (2): 437–41. doi:10.1016/j.fertnstert.2008.12.131. PMID 19217098.
  52. ↑ 52.0 52.1 52.2 52.3 McQueen DB, Bernardi LA, Stephenson MD (2014). "Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise". Fertil Steril. 101 (4): 1026–30. doi:10.1016/j.fertnstert.2013.12.031. PMID 24462055.
  53. ↑ Kitaya K (2011). "Prevalence of chronic endometritis in recurrent miscarriages". Fertil Steril. 95 (3): 1156–8. doi:10.1016/j.fertnstert.2010.09.061. PMID 21030015.
  54. ↑ Ghidini A, Salafia CM (2005). "Histologic placental lesions in women with recurrent preterm delivery". Acta Obstet Gynecol Scand. 84 (6): 547–50. doi:10.1111/j.0001-6349.2005.00694.x. PMID 15901265.
  55. ↑ Yang R, Du X, Wang Y, Song X, Yang Y, Qiao J (2014). "The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients". Arch Gynecol Obstet. 289 (6): 1363–9. doi:10.1007/s00404-013-3131-2. PMID 24395012.
  56. ↑ Eckert LO, Hawes SE, Wölner-Hanssen PK, Kiviat NB, Wasserheit JN, Paavonen JA; et al. (2002). "Endometritis: the clinical-pathologic syndrome". Am J Obstet Gynecol. 186 (4): 690–5. doi:10.1067/mob.2002.121728. PMID 11967492.
  57. ↑ 57.0 57.1 Kasius JC, Fatemi HM, Bourgain C, Sie-Go DM, Eijkemans RJ, Fauser BC; et al. (2011). "The impact of chronic endometritis on reproductive outcome". Fertil Steril. 96 (6): 1451–6. doi:10.1016/j.fertnstert.2011.09.039. PMID 22019126.
  58. ↑ 58.0 58.1 Michels TC (1995). "Chronic endometritis". Am Fam Physician. 52 (1): 217–22. PMID 7604765.
  59. ↑ 59.0 59.1 King, Tekoa (2015). Varney's midwifery. Burlington, MA: Jones & Bartlett Learning. ISBN 978-1-284-02541-5. OCLC 855888968.
  60. ↑ Rotterdam H (1978). "Chronic endometritis. A clinicopathologic study". Pathol Annu. 13 Pt 2: 209–31. PMID 748840.
  61. ↑ Yörükoğlu K, Kuyucouğlu F (1998). "Chronic nonspecific endometritis". Gen Diagn Pathol. 143 (5–6): 287–90. PMID 9653909.
  62. ↑ 62.0 62.1 62.2 Karsnitz DB (2013). "Puerperal infections of the genital tract: a clinical review". J Midwifery Womens Health. 58 (6): 632–42. doi:10.1111/jmwh.12119. PMID 24406036.
  63. ↑ Maharaj D (2007). "Puerperal Pyrexia: a review. Part II". Obstet Gynecol Surv. 62 (6): 400–6. doi:10.1097/01.ogx.0000266063.84571.fb. PMID 17511894.
  64. ↑ Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune A; et al. (2019). "Review: Chronic endometritis and its effect on reproduction". J Obstet Gynaecol Res. 45 (5): 951–960. doi:10.1111/jog.13937. PMID 30843321.
  65. ↑ Bayer-Garner IB, Nickell JA, Korourian S (2004). "Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis". Arch Pathol Lab Med. 128 (9): 1000–3. doi:10.1043/1543-2165(2004)128<1000:RSIAIT>2.0.CO;2. PMID 15335255.
  66. ↑ McQueen DB, Perfetto CO, Hazard FK, Lathi RB (2015). "Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss". Fertil Steril. 104 (4): 927–931. doi:10.1016/j.fertnstert.2015.06.044. PMID 26207958.
  67. ↑ 67.0 67.1 67.2 Bennett GL, Harvey WB, Slywotzky CM, Birnbaum BA (2003). "CT of the acute abdomen: gynecologic etiologies". Abdom Imaging. 28 (3): 416–32. doi:10.1007/s00261-002-0052-0. PMID 12719915.
  68. ↑ 68.0 68.1 Langer JE, Dinsmore BJ (1992). "Computed tomographic evaluation of benign and inflammatory disorders of the female pelvis". Radiol Clin North Am. 30 (4): 831–42. PMID 1631288.
  69. ↑ 69.0 69.1 Urban BA, Pankov BL, Fishman EK (1999). "Postpartum complications in the abdomen and pelvis: CT evaluation". Crit Rev Diagn Imaging. 40 (1): 1–21. PMID 10349536.
  70. ↑ 70.0 70.1 Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP; et al. (1993). "Imaging of pregnancy-related complications". Radiographics. 13 (4): 753–70. doi:10.1148/radiographics.13.4.8356266. PMID 8356266.
  71. ↑ 71.0 71.1 Zuckerman J, Levine D, McNicholas MM, Konopka S, Goldstein A, Edelman RR; et al. (1997). "Imaging of pelvic postpartum complications". AJR Am J Roentgenol. 168 (3): 663–8. doi:10.2214/ajr.168.3.9057511. PMID 9057511.
  72. ↑ Bennett GL, Slywotzky CM, Giovanniello G (2002). "Gynecologic causes of acute pelvic pain: spectrum of CT findings". Radiographics. 22 (4): 785–801. doi:10.1148/radiographics.22.4.g02jl18785. PMID 12110710.
  73. ↑ Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ (2015). "Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review". Obstet Gynecol. 125 (4): 789–800. doi:10.1097/AOG.0000000000000732. PMID 25751198.
  74. ↑ "Committee opinion no. 465: antimicrobial prophylaxis for cesarean delivery: timing of administration". Obstet Gynecol. 116 (3): 791–2. 2010. doi:10.1097/AOG.0b013e3181f68086. PMID 20733474.
  75. ↑ 75.0 75.1 75.2 Smaill FM, Gyte GM (2010). "Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section". Cochrane Database Syst Rev (1): CD007482. doi:10.1002/14651858.CD007482.pub2. PMC 4007637. PMID 20091635.
  76. ↑ Soar J, Peyton J, Leonard M, Pullyblank AM (2009). "Surgical safety checklists". BMJ. 338: b220. doi:10.1136/bmj.b220. PMID 19158173.
  77. ↑ Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J (2010). "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis". Am J Obstet Gynecol. 203 (3): 243.e1–8. doi:10.1016/j.ajog.2010.05.028. PMID 20598284.
  78. ↑ National Collaborating Centre for Primary Care (UK) (2006). "Postnatal Care: Routine Postnatal Care of Women and Their Babies". National Institute for Health and Clinical Excellence: Guidance. PMID 21834192.
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