What is endometritis?
Endometritis is a type of pelvic inflammatory disease (PID). Specifically, it is inflammation of the endometrium, the inner layer of the uterus – the layer that surrounds the uterine cavity and where pregnancy begins when a blastocyst, a kind of early embryo, implants. More accurately, the condition is called endomyometritis, because often the inflammation penetrates beyond the endometrial layer into the myometrium, the thick muscular layer that constitutes most of the mass of the uterus. Sometimes, the inflammation even reaches the outer layer of the uterus, the perimetrium. The inflammation is due to infection, typically an infection that occurs at delivery, just after delivery, or very late in pregnancy, so generally, endometritis is a post-partum condition (a problem the occurs after delivery). In the context of pregnancy, endometritis is generally acute, meaning that it develops quickly and is severe. In contrast, endometritis can be chronic (less intense but present over months to years with waxing and waning) but usually this occurs in women after menopause, rather than in connection with pregnancy. Thus, when we talk about endometritis in this report, generally, we are referring to acute endometritis.
How common is endometritis?
Endometritis is very common, occurring in approximately 15 percent of pregnancies, which makes it the leading cause of maternal death. Factors making endometritis more likely are situations that increase the chance of uterine infection – notably, a cesarean section (C-section) done in an emergency, rather than a C-section that is planned ahead of time. The reason is likely that rushed C-sections tend to be done after long, protracted labor that tends to produce prolonged rupture of fetal membranes and thus infection, particularly chorioamnionitis (bacterial infection and inflammation of the fetal membranes). Chorioamnionitis itself is a risk factor for endometritis. Apart from drawn out labor and C-section, various other procedures can trigger endometritis, including dilation and curettage (D&C, scraping of the uterus), use of an intrauterine device (IUD), and hysteroscopy), in other words, anything that can irritate the endometrium and expose it to a potential infection.
How is endometritis diagnosed?
Often endometritis is a clinical diagnosis, meaning that your obstetrician/gynecologist diagnoses it based on clinical judgment in the context of your symptoms, which can include fever, pelvic or lower abdominal pain, swelling in the abdomen, excessive vaginal bleeding, vaginal discharge, and bowel movement difficulty or constipation. Definitive diagnosis can be made based on culturing of samples from your cervix showing bacteria that commonly cause endometritis, such as Chlamydia trachomatis and Neisseria gonorrhoeae, based on biopsy of your endometrium showing inflammation, or when your ob/GYN looks at the endometrium in a laparoscopic procedure. Samples of your discharge also can be examined, plus doctors will order blood tests that will include a white blood cell count (which is affected by infection) and an erythrocyte sedimentation rate (ESR, which can reveal that there is inflammation in the body).
Does endometritis cause problems for the mother?
Yes. Endometritis can lead to life-threatening complications, such as sepsis (infection throughout the body), pelvic or uterine abscess (a bad infection), and peritonitis (infection and inflammation throughout the pelvic cavity.) Over the long term, the condition can lead to infertility.
Does endometritis cause problems for the baby?
Generally, the baby is out of you by the time that endometritis strikes, so really, this is a problem for the mother only.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself, if you do not treat the endometritis
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat endometritis?
The gold standard treatment for acute endometritis is a regimen consisting of the antibiotics clindamycin and gentamicin, given intravenously. Although there is evidence suggesting that gentamicin could pose a risk to the fetus, endometritis is generally a post-delivery condition. Thus, the issue of safety relates more to breastfeeding than to pregnancy (see below).
Who should NOT stop taking medication for endometritis?
Endometritis is a life-threatening condition, so you should not stop antibiotic treatment. If you have a reaction to an antibiotic, your doctor can switch you do a different regimen.
What should I know about choosing a medication for my endometritis?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my endometritis when I am breastfeeding?
As mentioned above, there is some concern about gentamicin in nursing mothers, so if you are given this drug for endometritis, you should consider holding off on nursing until you are finished with your treatment. Sometimes, an antibiotic called doxycycline is given when endometritis is chronic or subacute (less intense than acute endometritis, but more intense than chronic endometritis), or to prevent endometritis in surgical procedures. If you are taking doxycycline, you should avoid nursing.
What alternative therapies besides medications can I use to treat my endometritis?
When you have endometritis, there are various supportive treatments that doctors will provide, such as fluids, in addition to antibiotic therapy. However, there is no alternative to antibiotics.
What can I do for myself when I have endometritis?
It is very important to follow the instructions of your physician.
Resources for endometritis:
For more information about endometritis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: