Endometritis resident survival guide
Synonyms and keywords:Approach to acute endometritis, chronic endometritis, postpartum endometritis, puerperal endometritis

# Overview
Endometritis is inflammation of the uterine lining which can affect all layers of the uterus. The uterus is usually aseptic but the travel of microbes from the cervix and vagina can lead to inflammation and infection. 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.It commonly occurs as a result of the rupture of membranes during childbirth. It is the most common postpartum infection. Puerperal endometritis is 25 times more common in patients that underwent cesarean sections. Most cases of postpartum endometritis are polymicrobial, involving aerobic and anaerobic bacteria.

# Causes
Postpartum endometritis is caused by bacteria ascending from the lower genital tract into the cervix during labor. These bacterias that are the vaginal microflora include:
- Alpha hemolytic streptococci
- Corynebacterium
- Diphtheroids
- E.coli
- Enterobacter agglomerans, Enterobacter cloacae, Enterobacter aerogenes
- Fusobacterium necrophorum
- Klebsiella pneumoniae
- Lactobacillus crispatus, L casei, L jansei
- Mycoplasma genitalia, Mycoplasma hominis
- Nondescript streptococci
- Prevotella bivia, Prevotella melaninogenicus
- Staphylococcus epidermidis
- Ureaplasma urealyticum
Chronic endometritis:Common cause of chronic endometritis (CE) is an infection with microorganisms, including:
- 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
- Escherichia coli
- Streptococcus species
- Staphylococcus species
- Enterococcus faecalis
- Mycoplasma or ureaplasma species:
Mycoplasma genitalium
Mycoplasma hominis
Ureaplasma urealyticum
- Mycoplasma genitalium
- Mycoplasma hominis
- Ureaplasma urealyticum
- Proteus  species
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Gardnerella vaginalis
- Corynebacterium
- Yeasts:
Candida species
Saccharomyces cerevisiae
- Candida species
- Saccharomyces cerevisiae
Acute endometritis may be caused by Chlamydia trachomatis and Neisseria gonorrhea.
 Risk factors associated with puerperal endometritis include:
- Cesarean birth
- Surgical or instrumental birth
- Chorioamnionitis
- Prolonged rupture of membranes
- Retained placental fragments
- Postpartum hemorrhage
- Frequent vaginal examinations
- Colonization with group B Streptococcus
 Risk factors that have been reported to be associated with chronic endometritis (CE) include:
- Intrauterine contraceptive devices (continuous use)
- Prolonged menstruation
- Atypical uterine bleeding
- Fallopian tube obstruction
- Multiparity
- Abortion
- Bacterial vaginosis
- Endometrial hyperplasia
- Submucosal fibroids
- Endometriosis
- Endometrial osseous metaplasia
- Tuberculosis

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of Endometritis:
Abbreviations: BP: Blood pressure; RR=Respiratory rate;
HR=Heart Rate, IV= Intravenous

# Treatment
Shown below is an algorithm summarizing the treatment of mild endometritis.
Shown below is an algorithm summarizing the treatment of moderate to severe endometritis.
 Endometritis can cause complications including sepsis, abscesses, hematoma, septic pelvic thrombophlebitis and necrotizing fasciitis. Such complications can lead to uterine necrosiswhich may need a hysterectomy for infection resolution.
 Surgical intervention may also be necessary if the infection has produced a drainable fluid collection.

# Dos
- To reduce the risk of endometritis caused by STDs 
Patient should practise safe sex, such as using condoms.
Patient should get routine screening and early diagnosis of suspected STDs, in both herself and partner.
She should finish all treatment prescribed for an STD.
- Patient should practise safe sex, such as using condoms.
- Patient should get routine screening and early diagnosis of suspected STDs, in both herself and partner.
- She should finish all treatment prescribed for an STD.
- To reduce the risk of endometritis caused by caesarean section prophylactic antibiotics before cesarean deliveries should be given.
- Some of the measures that should be considered in order to reduce genital tract infections include:
Routine antepartum screening and treatment of GBS and infections
Handwashing
Aseptic procedure
Decrease in vaginal examinations
Limiting use of invasive procedures
Limiting episiotomies
Synthetic suture use
Decrease in cesarean births
Rapid repair of lacerations
Standard suture techniques
Prophylaxis with antibiotics in anal sphincter injuries
- Routine antepartum screening and treatment of GBS and infections
- Handwashing
- Aseptic procedure
- Decrease in vaginal examinations
- Limiting use of invasive procedures
- Limiting episiotomies
- Synthetic suture use
- Decrease in cesarean births
- Rapid repair of lacerations
- Standard suture techniques
- Prophylaxis with antibiotics in anal sphincter injuries

# Don'ts
- Do not hesitate to contact the physician if there are any signs of infection.