Myometrium

Myometritis is a serious uterine disease that is accompanied by inflammatory changes in the myometrium and requires immediate adequate treatment. This disease is most common in women of young reproductive age, which constitutes a danger of serious complications in the future. Therefore, it is important to know not only the basic principles of a symptomatic picture, but also to prevent this pathology.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

The epidemiology of myometrial development is such that most cases of detection of this disease, it is more than 95% - the patient of reproductive age, that is 25-35 years. This is very dangerous, because the basic function of the female organism is violated and later there may be problems with pregnancy, especially if pregnancy is the first. The incidence of myometritis, as an inflammatory disease of the female genitalia, ranks second among all pathologies after violations of the ovario-menstrual cycle. The most common myometrium associated with pregnancy or childbirth, it accounts for more than 80% of all cases of inflammation of the uterus. This is due to the fact that intervention during abortion or after childbirth always carries a potential threat of secondary infection of the uterine cavity with the development of a foci of infection. Therefore, it is necessary to know the most frequent and possible causes of myometrite development in women.

[8], [9], [10], [11]

Causes of the myometrite

Myometritis is an inflammation of the muscular layer of the uterus. The uterus inside is formed by the endometrium, then there is a muscle layer - the myometrium, and then the last layer that surrounds the uterus is a parameter. Isolated inflammation of the myometrium is less common than endomyometritis, since all the layers are tightly connected.

The most common cause of myometrial development in women of reproductive age is postpartum septic states. Usually, during normal births, physiological blood loss occurs, which contributes to a small purification of the birth canal, not only from the placenta remnants, but also from some microorganisms. But with pathological births, and even more so with surgical interventions, there is an obligatory upward infection of the birth canal with pathogenic microorganisms, which are the cause of myometrite development. Therefore, it can be said that surgical interventions during childbirth or immediately after them increase the risk of developing myometrium in the future, which should be taken into account when diagnosing this pathology.

Another frequent cause of myometrial development can be a chronic foci of inflammation of the internal genital organs. Very often there is chronic adnexitis or chronic oophoritis, which does not have adequate treatment, and the chronic focus of infection is maintained all the time. Such a focus is the source of the development of chronic myometrium, which has an asymptomatic course and therefore this process is sustained for a long time. This once again proves the need to treat any inflammatory diseases of the internal genitalia.

Another reason for the development of myometrium is frequent diseases of the urogenital tract, both specific and nonspecific. Frequent cystitis, chronic pyelonephritis, urethritis, vaginitis and colpitis are also a source of myometrial infection.

A very frequent reason for the development of myometrium in women over 35 is the upward infection through the establishment of contraceptives - the uterine spirals. If there is a persistent infection of the genital tract, then before such a method it is necessary to conduct preventive treatment, and only then to establish a spiral. It also happens that women do not adhere to the recommendations, and such a spiral does not change after five years, then there are processes of traumatizing the myometrium and when the microorganism hits, myometrium is easily developed.

As for the most frequent pathogens, a huge role here belongs to microorganisms from the group of staphylococci, streptococci, especially greening streptococcus, ureoplasm, proteus, as well as Pseudomonas aeruginosa and Escherichia coli.

[12], [13], [14], [15], [16]

Risk factors

It is also necessary to identify the risk factors for the development of myometrium, which should be taken into account and women from this group should regularly monitor and carry out preventive measures. The risk group includes women who have:

• chronic inflammation of the ovaries or appendages;
• frequent inflammatory diseases of the kidneys and urinary tract;
• accompanying vaginitis, colpitis during pregnancy;
• postoperative inflammatory complications in anamnesis;
• women after a criminal abortion;
• women with violations ovario-menstrual cycle.

These are the main reasons for the development of myometrium, which must be taken into account when collecting anamnesis, as well as during treatment.

[17], [18]

Pathogenesis

As for the pathogenesis of the development of myometrium, it all begins with the entry of the pathogen into the myometrium, which most often occurs in an ascending manner. After that, the microorganism penetrates into the myometrium cells and starts to destroy them, what the immune system reacts to, and leukocytes and inflammation factors are released. If this process develops sharply and the number of microorganisms is considerable, then acute inflammation develops, and if there are few microorganisms, then a constant focus of inflammation in the myometrium is maintained.

[19], [20], [21], [22], [23], [24], [25], [26]

Symptoms of the myometrite

Speaking about the clinical picture of myometrium, it is necessary to divide into two main types - acute and chronic myometrium. Acute myometrium has a pronounced clinical picture from the very beginning of the disease, and it has a rapid course. The first signs of such a myometrium are the appearance of pulling aching pains in the lower abdomen that are not associated with the menstrual cycle, as well as in the presence of inflammatory diseases of the genitals or urinary tract in the past. In this case also there are pus-like discharge from the uterus. Also expressed intoxication syndrome, which manifests itself as a hectic rise in body temperature, an increase in general weakness, dizziness, decreased efficiency. All these symptoms appear immediately, on the first day of the disease and their severity increases. Over time, the pain in the abdomen increases, and intoxication becomes more pronounced.

With chronic myometrium, the symptoms are similar, but their severity is not so bright. At the same time, body temperature is subfebrile with a slight weakness and lethargy, which is difficult to explain. Also, with chronic myometrium, as a rule, there are no special secretions, since the process is slow, and can only be a violation of the normal biocenosis of the vagina with the development of concomitant, often recurring candidiasis or vaginosis.

A separate type of this pathology is chronic myometrium with fibrosis. It develops most often against a background of permanent traumatization, for example, an intrauterine device. In this case, in the myometrium along with inflammation foci there are also lesions of fibrosis, as a mechanism for replacing damaged tissue. The clinical course of this type of myometrium is the calmest - there can only appear periodic pulling pains throughout the abdomen, secretion, as a rule, not, and there may also be a minor subfebrile condition.

If myometrium is a postpartum process, then on the second or third day after giving birth, the woman's body temperature rises, there is pain in the abdomen, and there may also be development of mastitis, which often indicates a problem with the uterus. Therefore, the development of mastitis after childbirth, which is difficult to treat, may indicate the onset of a pathological process in the uterus in the form of a myometrium.

Also postpartum myometrium has developmental stages that are taken into account to assess the prevalence of the process. The first stage is when the septic process is limited to the wound surface, that is, does not go beyond the focus of the infection and is expressed by a local myometrium. The second stage of the process is spreading to the uterine wall with the development of diffuse myometrium, endomyometritis or parametritis, but the process does not extend outside the uterus. The third stage is characterized by involvement in the pathological process of the pelvic organs, in which the myometrium spreads further and develops pelvic peritonitis, peritonitis, parametritis. The fourth stage of the disease is the most serious and then the process is widespread with the development of a generalized infection.

The peculiarity of this process is that the degree of intoxication increases proportionally with the increase in the stage of the inflammatory process. If the process is very pronounced, then the condition of such a woman is extremely severe and the symptomatology is very pronounced.

The clinical signs of myometrium, which develops as a result of prolonged traumatization, with prolonged wearing of the spiral, are also pronounced drawing pains in the abdomen. Sometimes in chronic form this can be the only symptom that women do not pay attention to at first, but this is an important diagnostic sign, so you need to take it into account.

These are the main symptoms of myometrium, which can give an occasion to consult a doctor, because any abdominal pain is a serious symptom that can not be ignored.

Complications and consequences

Speaking about the possible complications of myometrium, it should be said that this is a serious inflammatory disease and due to this localization of the process it can very quickly spread to the pelvic organs and abdominal cavity. This can provoke the development of a complication such as peritonitis, which requires immediate surgery. Even more serious consequences may be myometrium, as a source of sepsis, which is also very dangerous and has an unfavorable prognosis. Later consequences of the transferred myometrium may be in the form of infertility due to the formation of adhesions in the uterine cavity and impaired implantation of the fetal egg.

[27], [28], [29], [30], [31], [32]

Diagnostics of the myometrite

It is very important to timely diagnose the myometrium with timely differential diagnosis, as correct timely treatment is very important to prevent the spread of the process.

First of all, the diagnosis must begin with the details of complaints. If a woman is in the postpartum period and during labor was an operative intervention, then the appearance of any complaints from the uterus should alert. It is necessary to find out when the symptoms first appeared, whether it was accompanied by an increase in body temperature or pathological discharge from the uterus or not. It is necessary to find out the history of life and the presence of chronic inflammatory processes of the appendages or other organs, because this can be a hotbed of active infection.

Be sure to examine the woman on the chair. In this case, it is possible to see ruptures or damage to the genital tract, which can be a hotbed of infection, as well as the presence of purulent discharge in the uterine cavity. With palpation the uterus will be painful all over, it will be a testate of consistency, parametric fiber and space will be free during the first and second stages of the process. If the appendages are not involved in the process, they will not be revealed by palpation. If a woman after childbirth, then the lochia will be blood-purulent, and also the soreness of the chest will be palpated with the likely development of mastitis. These are the main objective signs that can be identified by a local examination.

To verify the diagnosis and choose the right treatment tactics, it is necessary to conduct additional research methods in a rapid mode.

Analyzes that are mandatory are a general blood test, a smear from the cervix and bacteriological examination of the uterine secretions, as well as a bacterioscopic examination with identification of the type of pathogen and its sensitivity to different antibiotics.

In the general analysis of the blood there may be changes in the inflammatory nature that are very pronounced - significant leukocytosis with a shift of the leukocyte formula to the left, an increase in ESR - all this indicates a serious inflammatory reaction from the blood. As for the smear, it is examined under a microscope for a bacterial flora, and the type of pathogen and its condition with respect to Gram staining can be determined, which will make it possible to guess the pathogen and select a group of antibiotics. A more precise method of identifying the pathogen is bacteriological. It makes it possible to accurately identify the pathogen, but its shortcoming in long-term diagnosis, when treatment should already be conducted. For the correct and most accurate tactics of choosing a drug for treatment, it is necessary to determine the sensitivity of the microbe to individual antibiotics, which is also important in diagnosing the process. But this is also a delayed result, so often treatment is prescribed empirically before the results are obtained.

Instrumental diagnosis of myometrium is very important not only to confirm the diagnosis, but also to determine the boundaries of the inflammatory process and the severity of the myometrium.

The "gold standard" of instrumental diagnosis of myometrium is ultrasound. This method is based on the passage of ultrasonic waves through the heterogeneous tissues of the body and the reflection of these waves, which makes it possible to see the picture. In this case, the myometrium due to infiltration by leukocytes and other inflammatory cells becomes an inhomogeneous structure, which can be detected on ultrasound, as the main diagnostic feature. Therefore, the heterogeneous structure of the myometrium, the change in echogenicity are signs of a pathological process in the uterus. To verify the exact location, the organs of the small pelvis and endometrium are also examined, which will also change the echogenicity if the inner layer of the uterus is involved in the pathological process.

Diagnostic curettage of the uterine cavity with further histological examination of secretions is used in case of suspicion of postpartum myometrium, caused by the placenta remains in the uterine cavity. Then this procedure is not only diagnostic, but also therapeutic.

[33], [34], [35], [36], [37], [38], [39], [40]

Differential diagnosis

Differential diagnosis of myometrium should be performed with other inflammatory diseases of the uterus and ovaries, as well as with abdominal cavity abnormalities with severe symptoms of the acute abdomen.

Inflammation of the uterine appendages can also have manifestations of an intoxication syndrome with pain in the abdomen. But with inflammation of the ovaries, the process is localized not at the bottom of the abdomen, but in the side, which is important to keep in mind in differential diagnosis.

The clinic of the acute abdomen can also be provoked by pain with myometrium, but it is necessary to carry out diagnostics with appendicitis and peritonitis. With appendicitis or peritonitis, local symptoms of peritoneal stress will be detected, and myometrium does not give such a symptomatology, pain will only be with bimanual palpation of the uterus.

The prevalence of the inflammatory process can be identified by ultrasound and differentiate myometrium and endomyometritis, the parameter.

Treatment of the myometrite

In the treatment of myometrium, priority should first of all be directed to the prevention of complications. Therefore, the main task is to eliminate the focus of inflammation and prevent it from spreading further to the pelvic organs and peritoneum. Priority in the treatment of myometrium have antibiotics, as well as anti-inflammatory agents of local action. In choosing an antibiotic for treatment, the main principle should be etiological - the choice of the drug should be based on the sensitivity of the pathogen. But the result of the study with precise identification of the pathogen can be on the third - fifth day of the disease, and by that time antibacterial therapy is already needed. Therefore, the drug is administered empirically, taking into account a possible causative agent, and as a rule, it is a broad-spectrum antibiotic.

Cefoperazone is a beta-lactam antibiotic from the group of cephalosporins of the 3rd generation, which has a pronounced bactericidal effect on gram-positive and gram-negative microorganisms, that is, it covers a huge range of microbes. This makes it possible to use it for the treatment of myometritis with an undifferentiated pathogen. The drug is produced in a pharmacological form of powder for injection at 500 milligrams, 1 and 2 grams. The drug is used in a dose of 1 gram per day, is administered intramuscularly or intravenously at intervals of 12 hours. The course of treatment is 7-10 days.

Contraindications to prescription are allergic reactions to penicillins or other beta-lactam antibiotics. Precautions - it is necessary to use with caution the drug with concomitant atopic bronchial asthma.

There is no negative effect on the fetus during pregnancy, so you can take the drug and during pregnancy, but when feeding the baby, it is necessary to stop feeding from the time of treatment, as this can cause antibiotic-associated diarrhea in the child. Side effects are possible on the part of the gastrointestinal tract, allergic manifestations, reactions of the nervous system in the form of headache, drowsiness, dizziness. It is also possible to transiently increase hepatic enzymes.

Stellate is a combined bicomponent, which has a high effectiveness in the treatment of septic diseases of the genital organs and prevention of peritoneal damage. This drug has in its composition Gatifloksatsin and Ornidazole. Gatifloxacin is a broad-spectrum antibiotic from the group of 4th generation fluoroquinolones. It affects many microorganisms - staphylococci, streptococci, proteus, klebsiels, legionella, as well as some anaerobes. The mechanism of action of the drug is its bactericidal properties by inhibiting the synthesis of the DNA of the bacterium cell, which disrupts its division. Ornidazole is a drug that also acts on the synthesis of DNA, mainly acting on intracellular bacteria and anaerobes. Therefore, the combined effect of these two drugs has a pronounced antibacterial effect. The drug is produced in a pharmacological form of 500 milligram tablets. Dosage of the drug - one tablet twice a day. Precautions - the drug should not be used during pregnancy, because there is no data on the safety of this drug. Side effects are possible on the part of the gastrointestinal tract, allergic manifestations, nervous system reactions in the form of headache, drowsiness, dizziness, impaired coordination. Also, there are possible dysuric manifestations that are transitory in nature.

Ciprolet is an antibacterial drug that has a broad antibacterial effect against the flora of the genitourinary system. This drug from the group of fluoroquinolones and it acts on microorganisms by inhibiting the synthesis of bacterial cell DNA. The drug is issued pharmacological form of tablets and vials for injections of 100 milliliters. The dosage of the drug is 200 milligrams twice a day in an acute period, that is, one ampoule is dripwise intravenously. Precautions - the drug should not be used during pregnancy, because there is no data on the safety of this drug. Side effects are possible on the part of the nervous system in the form of loss of balance, impaired coordination, dizziness, as well as skin allergic manifestations and decreased blood cells.

Ketoprofen is a drug from a group of non-steroidal anti-inflammatory drugs that has an anti-inflammatory, anti-edematous, antimicrobial effect. It also relieves, pain, signs of irritation and inflammation, which contributes to a better effect along with the use of an antibiotic. In the complex treatment of myometrium, this group of drugs has an additional effect and helps to reduce the local inflammatory process, which increases the rate of regeneration of the myometrium. Produced in the form of suppositories for topical therapy at 100 milligrams. Candles are injected rectally twice a day after the toilet of the genitals. The course of treatment is twelve days.

Contraindications to the use of the drug are allergic reactions in the anamnesis, bronchial asthma, as well as pathology of the gastrointestinal tract in the form of peptic ulcer of the stomach or duodenum, intestinal bleeding, hyperacid gastritis.

Adverse events are possible on the part of the gastrointestinal tract in the form of glossitis, lesions of the esophagus, stomach, intestines with dyspepsia, violation of evacuation function of the intestine. Also possible allergic manifestations of varying severity. When the drug acts on the hematopoietic system, anemia, a decrease in the number of platelets and granulocyte neutrophils may occur.

When acting on the heart and the vascular system, there may be an increased heart rate, pain in the heart, heart rhythm disturbance, lability of blood pressure.

Vitamins and physiotherapy are used in the period of convalescence to reduce the risk of further adhesions in the uterine cavity or the persistence of a chronic foci of infection. Use local magnetotherapy or laser therapy.

Surgical treatment of myometrium is sometimes the only way out in the radical treatment of pathology. If myometrium is in the third or fourth stage, and it is caused by a postoperative complication, then it is already a radical surgery in the form of extirpation of the uterus, as the main and more dangerous focus of infection. Sometimes, medical surgical manipulation can be performed in the form of scraping out the uterine cavity, if it is a question of spreading the myometrium to the endometrium.

Alternative treatment of myometrium

It should be said that alternative treatment of myometrium is of secondary importance, since it is an acute inflammatory process that requires active treatment. Therefore, alternative treatment methods can be used in combination with antibiotic therapy.

The main alternative recipes:

1. Very useful therapeutic antiseptic syringing with solutions of herbs. To prepare a recipe you need to take a teaspoon of the hog chaff, althea and plantain, all this you need to fill with a liter of hot boiled water, insist for ten to twenty minutes, then in a warm form to carry out syringing. This solution needs to be typed in a pear and spend syringing, preferably twice a day with a course of treatment a week.
2. Aloe vera helps to restore the damaged endometrium and has a bactericidal effect, which is very useful for the chronic form of myometrium. For treatment, the aloe juice is squeezed into the bowl, then dipped gauze in this juice and inserted into the vagina for three to four hours. Such procedures should be repeated twice a day for ten days.
3. An effective agent for suppressing the inflammatory process in the uterus is the use of sea-buckthorn candles, which apart from bactericidal action have an antioxidant and regenerating effect. You can use special candles, and you can make a medicine at home. To do this, in the sea-buckthorn oil you need to lubricate the tampon and put it into the vagina for the night. This will also express the mitigating effect of this medication.

Herbs are also used in the treatment of myometrium and the main effect of such treatment is directed to the general strengthening effect of the body and immunomodulating. The main herbs that are used in this case are as follows:

1. The altei herb has a general strengthening effect on the whole organism. It is taken in the form of a decoction, which is prepared by tincturing the herb in boiling water. Dosage - one glass a day in the morning, on an empty stomach. Duration of treatment can be up to two weeks, and after recovery you can repeat the course.
2. It is said about the high benefits of combining viburnum and St. John's wort for the treatment of myometrium. For such a medicine, you need to wipe the berries of the viburnum, then add the tincture of St. John's wort there and take this medicine on a teaspoon three times a day.
3. Tincture from the elm bark is taken on a teaspoon three times a day in an acute period to reduce the local inflammatory process. For this, the bark is poured with a cup of hot water and insisted for a long time, about six hours. Take in a cooled form.

Homeopathic remedies are also used in complex treatment of myometrium, but they have a slightly different goal - they are taken on recovery to restore the endometrium and myometrium, which was damaged by the inflammatory process by increasing the concentration of progesterone, and also to prevent the formation of adhesions in the uterus and tubes. The main preparations of the homeopathic series:

1. Agnus Cosmoplex C is a combined homeopathic remedy that affects all disturbances in the regulation processes in the body. And also due to the rich plant composition has anti-inflammatory effect with tropism to the genitourinary system. This allows the drug to be used as an additional therapy for myometrium, which regulates the disruption of the structure of the uterine wall and restores the structure with the prevention of the development of the adhesion process. Agnus Cosmoplex C is produced in the pharmacological form of rectal suppositories and dosed one candle twice a day after hygienic procedures. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions, as well as local reactions in the form of itching, burning. When pregnancy can be applied with the advice of a doctor.
2. Arnika-Heel is a combined homeopathic remedy, which is used most often for the treatment of slow chronic myometrium, which is accompanied by a long subfebrile temperature. Arnika-Heel is manufactured in the pharmacological form of homeopathic drops and dosed 10 drops an hour after eating. Precautions - patients with allergies to tomatoes should be taken carefully. Adverse events were not identified.
3. Petroleum is a combined homeopathic remedy, which is used most often for the treatment of slow chronic myometrium, provoked by the use of spirals during prolonged traumatization of the myometrium. The drug has a healing effect, which accelerates the process of regeneration of the myometrium. Petroleum is produced in the pharmacological form of homeopathic granules and drops are dosed three times a day three times a day half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not washed down with water. Side effects are not common. Perhaps a slight increase in pain in the abdomen, then you need to increase the dose to five drops.
4. Sulfur is a homeopathic remedy of natural non-living origin. The drug has a healing effect, antibacterial and regenerating, which has a good effect on the restoration of the myometrium and prevents the development of the chronization process. The drug is released in the pharmacological form of homeopathic granules and drops are dosed three granules three times a day for half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not washed down with water. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. Precautions - it is impossible to use the drug for an acute process in the uterus, it is better to appoint it after the course of antibiotic therapy.

[41], [42], [43], [44], [45], [46], [47], [48], [49]

Prevention

Prophylaxis of myometrite development is non-specific: regular check-ups at the gynecologist, timely treatment with abdominal pain, and treatment of chronic foci of infection on time. Specific prophylaxis of myometrial development concerns mainly the postpartum period and consists in prescribing antibiotics after cesarean section or other surgical intervention on the uterus.

[50], [51], [52], [53], [54], [55],

Forecast

In general, the prognosis of the myometrium with timely treatment can be favorable, and the uterus itself can be preserved, but it is necessary to diagnose in time all pathological conditions and possible disorders.

Myometritis is a frequent pathology, which is a complication of the postpartum period and carries a potential threat not only to the reproductive function of women, but also to her life. But there is a myometrium, which is caused by other causes, so you need to know the main symptoms in order to start treatment in time. We need to monitor our health, especially women, who will all become mother in the future, and more than once, so you need to take care of yourself.