Myometritis

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

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Epidemiology

The epidemiology of myometritis development is such that the majority of cases of detection of this disease, more than 95%, are patients of reproductive age, i.e. 25-35 years. This is very dangerous, since the main function of the female body is disrupted and problems with pregnancy may arise in the future, especially if the pregnancy is the first. The incidence of myometritis, as an inflammatory disease of the female genital organs, ranks second among all pathologies after ovariomenstrual cycle disorders. Myometritis associated with pregnancy or childbirth is most common, it accounts for more than 80% of all cases of uterine inflammation. 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 an infection focus. Therefore, it is necessary to know the most common and possible causes of myometritis in women.

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Causes myometritis

Myometritis is an inflammation of the muscular layer of the uterus. The uterus is formed internally by the endometrium, then comes the muscular layer – the myometrium, and then the last layer that surrounds the uterus is the parametrium. Isolated inflammation of the myometrium is less common than endometritis, since all layers are tightly connected to each other.

The most common cause of myometritis in women of reproductive age is postpartum septic conditions. Usually, during normal births, physiological blood loss occurs, which contributes to a slight cleansing of the birth canal not only from the remains of the placenta, but also from some microorganisms. But during pathological births, and especially during surgical interventions, there is a mandatory ascending infection of the birth canal with pathogenic microorganisms, which are the cause of myometritis. Therefore, it can be said that surgical interventions during childbirth or immediately after them increase the risk of myometritis in the future, which must be taken into account when diagnosing this pathology.

Another common cause of myometritis may be a chronic inflammation of the internal genital organs. Chronic adnexitis or chronic oophoritis is very common, which does not have adequate treatment, and the chronic infection is maintained all the time. Such a focus is the source of chronic myometritis, which has an asymptomatic course and therefore such a process is maintained for a long time. This once again proves the need to treat any inflammatory diseases of the internal genital organs.

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

A very common cause of myometritis in women over 35 is ascending infection due to the installation of contraceptives - uterine spirals. If there is a persistent infection of the genital tract, then before this method it is necessary to carry out preventive treatment, and only then install the spiral. It also happens that women do not follow the recommendations, and such a spiral is not changed after five years, then the processes of traumatization of the myometrium occur and when a microorganism gets in, myometritis easily develops.

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

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Risk factors

It is also necessary to highlight the risk factors for the development of myometritis, which must be taken into account and women from this group should be regularly examined and preventive measures taken. The risk group includes women who have:

• chronic inflammation of the ovaries or appendages;
• frequent inflammatory diseases of the kidneys and urinary tract;
• concomitant vaginitis, colpitis during pregnancy;
• history of postoperative inflammatory complications;
• women after a criminal abortion;
• women with ovariomenstrual cycle disorders.

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

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Pathogenesis

As for the pathogenesis of myometritis, it all begins with the pathogen entering the myometrium, which most often occurs in an ascending manner. After this, the microorganism penetrates the cells of the myometrium and begins to destroy them, to which the immune system reacts, and leukocytes and inflammatory factors are released. If this process develops acutely and the number of microorganisms is significant, then acute inflammation develops, and if there are few microorganisms, then a constant source of inflammation in the myometrium is maintained.

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Symptoms myometritis

When talking about the clinical picture of myometritis, it is necessary to divide it into two main types - acute and chronic myometritis. Acute myometritis has a pronounced clinical picture from the very beginning of the disease, and it has a rapid course. The first signs of such myometritis are the appearance of nagging, aching pains in the lower abdomen, which 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. At the same time, purulent discharge from the uterus also immediately appears. Intoxication syndrome is also expressed, which is manifested by a hectic rise in body temperature, increasing general weakness, dizziness, and decreased performance. All these symptoms appear immediately, on the first day of the disease, and their severity increases. Over time, abdominal pain intensifies, and intoxication becomes more pronounced.

With chronic myometritis, the symptoms are similar, but their severity is not so pronounced. In this case, the body temperature is subfebrile with slight weakness and lethargy, which is difficult to explain. Also, with chronic myometritis, as a rule, there is no special discharge, since the process is sluggish, and there may only be a violation of the normal biocenosis of the vagina with the development of concomitant, frequently recurring candidiasis or vaginosis.

A separate type of this pathology is chronic myometritis with fibrosis. It develops most often against the background of constant trauma, for example, by an intrauterine device. At the same time, in the myometrium, along with foci of inflammation, there are also foci of fibrosis, as a mechanism for replacing damaged tissue. The clinical course of this type of myometritis is the calmest - only periodic nagging pains throughout the abdomen may appear, there is usually no discharge, and there may also be a slight subfebrile temperature.

If myometritis is a postpartum process, then on the second or third day after childbirth, the woman's body temperature rises, abdominal pain appears, and mastitis may also develop, 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 myometritis.

Postpartum myometritis also has stages of development, which 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, i.e. does not go beyond the infection site and is expressed by local myometritis. The second stage of the process is the spread to the uterine wall with the development of widespread diffuse myometritis, endomyometritis or parametritis, but the process does not extend beyond the uterus. The third stage is characterized by the involvement of the pelvic organs in the pathological process, in which myometritis spreads further and pelvic peritonitis, peritonitis, parametritis develop. 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 such a 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 symptoms are very pronounced.

Clinical signs of myometritis, which develops as a result of long-term trauma, with prolonged wearing of the coil - are also pronounced pulling pains in the abdomen. Sometimes in the 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 it should be taken into account.

These are the main symptoms of myometritis, which may give reason to see a doctor, because any abdominal pain is a serious symptom that cannot be ignored.

Complications and consequences

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

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Diagnostics myometritis

It is very important to conduct a timely diagnosis of myometritis with timely differential diagnosis, since correct and timely treatment is very important to prevent the spread of the process.

First of all, diagnostics should begin with a detailed description of complaints. If a woman is in the postpartum period and there was surgery during childbirth, then the appearance of any complaints from the uterus should be alarming. 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 anamnesis data and the presence of chronic inflammatory processes of the appendages or other organs, because this may be a source of active infection.

It is necessary to examine the woman on the chair. In this case, it is possible to see ruptures or damage to the genital tract, which may be a source of infection, as well as the presence of purulent discharge in the uterine cavity. When palpating, the uterus will be painful throughout its entire length, it will be of a doughy consistency, the parametric tissue and space will be free at the first and second stages of the process. If the appendages are not involved in the process, they will not be detected by palpation. If the woman is postpartum, the lochia will be bloody-purulent, and there will also be breast pain when palpating with the probable development of mastitis. These are the main objective signs that can be identified during a local examination.

To verify the diagnosis and select the correct treatment tactics, additional research methods must be carried out quickly.

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

In a general blood test, there may be changes of an inflammatory nature that are very pronounced - significant leukocytosis with a shift in 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 bacterial flora and the type of pathogen and its condition in relation to Gram staining can be determined, which will make it possible to assume the causative agent of the process and select a group of antibiotics. A more accurate method of identifying the pathogen is bacteriological. It makes it possible to accurately identify the pathogen, but its disadvantage is in long-term diagnostics, when treatment should already be carried out. 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 treatment is often prescribed empirically until the results are obtained.

Instrumental diagnostics of myometritis is very important not only for confirming the diagnosis, but also for determining the boundaries of the inflammatory process and the severity of myometritis.

The "gold standard" of instrumental diagnostics of myometritis is ultrasound. This method is based on the passage of ultrasound waves through 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 heterogeneous in structure, which can be detected by ultrasound as the main diagnostic sign. Therefore, the heterogeneous structure of the myometrium, a change in echogenicity are signs of a pathological process in the uterus. To verify the exact localization, the pelvic organs and the endometrium are also examined, which will also change echogenicity if the inner layer of the uterus is involved in the pathological process.

Diagnostic curettage of the uterine cavity with subsequent histological examination of the discharge is used in cases of suspected postpartum myometritis, the cause of which are placental remnants in the uterine cavity. Then this procedure is not only diagnostic, but also therapeutic.

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Differential diagnosis

Differential diagnostics of myometritis should be carried out with other inflammatory diseases of the uterus and ovaries, as well as with pathology of the abdominal organs with pronounced symptoms of acute abdomen.

Inflammation of the uterine appendages may also have manifestations of intoxication syndrome with abdominal pain. But with inflammation of the ovaries, the process is localized not in the lower abdomen, but in the side, which is important to keep in mind during differential diagnostics.

The acute abdomen clinic can also be provoked by pain in myometritis, but it is necessary to conduct diagnostics with appendicitis and peritonitis. In appendicitis or peritonitis, local symptoms of abdominal tension will be revealed, and myometritis does not give such symptoms, pain will be only during bimanual palpation of the uterus.

The prevalence of the inflammatory process can be determined using ultrasound data and myometritis and endometritis, parametritis can be differentiated.

Treatment myometritis

In the treatment of myometritis, the priority should be primarily aimed at preventing the development of complications. Therefore, the main task is to eliminate the source of inflammation and prevent it from spreading further to the pelvic organs and peritoneum. Antibiotics and local anti-inflammatory drugs have priority in the treatment of myometritis. In choosing an antibiotic for treatment, the main principle should be the etiological one - the choice of the drug should be based on the sensitivity of the pathogen. But the result of the study with the exact identification of the pathogen can be on the third to fifth day of the disease, and by that time antibacterial therapy should already be carried out. Therefore, the drug is prescribed empirically, taking into account the possible pathogen, and as a rule, it is a broad-spectrum antibiotic.

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

Contraindications for use are allergic reactions to penicillins or other beta-lactam antibiotics. Precautions - the drug should be used with caution in concomitant atopic bronchial asthma.

No negative impact on the fetus during pregnancy has been identified, so the drug can be taken during pregnancy, but when breastfeeding, it is necessary to stop breastfeeding for the duration of treatment, as this can cause antibiotic-associated diarrhea in the child. Side effects are possible from the gastrointestinal tract, allergic reactions, nervous system reactions in the form of headache, drowsiness, dizziness. A transient increase in liver enzymes is also possible.

Stillat is a combined two-component agent that is highly effective in the treatment of septic diseases of the genital organs and the prevention of peritoneal lesions. This drug contains Gatifloxacin and Ornidazole. Gatifloxacin is a broad-spectrum antibiotic from the 4th generation fluoroquinolone group. It affects many microorganisms - staphylococci, streptococci, proteus, klebsiella, legionella, as well as some anaerobes. The mechanism of action of the drug lies in its bactericidal properties due to the inhibition of DNA synthesis of the bacterial cell, which disrupts its division. Ornidazole is a drug that also affects DNA synthesis, mainly affecting intracellular bacteria and anaerobes. Therefore, the combined action of these two drugs has a pronounced antibacterial effect. The drug is available in the pharmacological form of tablets of 500 milligrams. The dosage of the drug is one tablet twice a day. Precautions - the drug should not be used during pregnancy, since there is no data on the safety of this drug. Side effects are possible from the gastrointestinal tract, allergic reactions, nervous system reactions in the form of headache, drowsiness, dizziness, impaired coordination. Dysuric manifestations are also possible, which are transient in nature.

Ciprolet is an antibacterial drug that has a broad antibacterial effect on the flora of the genitourinary system. This drug is from the fluoroquinolone group and it affects microorganisms by inhibiting the synthesis of bacterial cell DNA. The drug is available in the pharmacological form of tablets and injection vials of 100 milliliters. The dosage of the drug is 200 milligrams twice a day in the acute period, that is, one ampoule intravenously by drip. Precautions - the drug cannot be used during pregnancy, since there is no data on the safety of this drug. Side effects are possible from the nervous system in the form of loss of balance, impaired coordination, dizziness, as well as skin allergic reactions and a decrease in blood cells.

Ketoprofen is a drug from the group of non-steroidal anti-inflammatory drugs, which has 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 myometritis, 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. It is produced in the form of suppositories for local therapy of 100 milligrams. Suppositories are inserted rectally twice a day after toilet of the genitals. The course of treatment is twelve days.

Contraindications to the use of the drug are a history of allergic reactions, bronchial asthma, as well as gastrointestinal tract pathology in the form of gastric ulcer or duodenal ulcer, intestinal bleeding, hyperacid gastritis.

Side effects are possible from the gastrointestinal tract in the form of glossitis, damage to the esophagus, stomach, intestines with dyspepsia, and disturbances in the evacuation function of the intestines. Also possible are allergic manifestations of varying severity. When the drug affects the hematopoietic system, anemia, a decrease in the number of platelets and granulocytic neutrophils may occur.

When acting on the heart and vascular system, rapid heartbeat, pain in the heart area, irregular heartbeat, and lability of blood pressure may occur.

Vitamins and physiotherapy are used during the recovery period to reduce the risk of further development of adhesions in the uterine cavity or persistence of a chronic source of infection. Local magnetic therapy or laser therapy are used.

Surgical treatment of myometritis is sometimes the only way out in the radical treatment of pathology. If myometritis is at the third or fourth stage, and it is caused by a postoperative complication, then we are talking about radical surgical intervention in the form of extirpation of the uterus, as the main and more dangerous source of infection. Sometimes a therapeutic surgical manipulation can be performed in the form of scraping the uterine cavity, if we are talking about the spread of myometritis to the endometrium.

Folk treatment of myometritis

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

Basic folk recipes:

1. Medicinal antiseptic douches with herbal solutions are very useful. To prepare the recipe, you need to take a teaspoon of the uterus of the forest, marshmallow and plantain, pour all this with a liter of hot boiled water, insist for ten to twenty minutes, then douche in a warm form. This solution should be collected in a pear and douche, preferably twice a day with a course of treatment of a week.
2. Aloe juice helps restore damaged endometrium and has a bactericidal effect, which is very good to use in the chronic form of myometritis. For treatment, aloe juice is squeezed into a container, then a gauze tampon is dipped 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 means for suppressing the inflammatory process in the uterus is the use of sea buckthorn suppositories, which in addition to the bactericidal effect have an antioxidant and regenerating effect. You can use special suppositories, or you can make the medicine at home. To do this, you need to lubricate a tampon in sea buckthorn oil and insert it into the vagina overnight. This will also express the softening effect of this medicine.

Herbs are also used in the treatment of myometritis and the main effect of such treatment is aimed at the general strengthening effect of the body and immunomodulatory. The main herbs that are used in this case are the following:

1. Marshmallow herb has a general strengthening effect on the entire body. It is taken in the form of a decoction, which is prepared by infusing the herb in boiling water. Dosage - one glass once a day in the morning, on an empty stomach. The duration of treatment can be up to two weeks, and after recovery, the course can be repeated.
2. They say that the combination of viburnum and St. John's wort is very useful for treating myometritis. To make this medicine, you need to rub the viburnum berries, then add St. John's wort tincture and take this medicine one teaspoon three times a day.
3. Elm bark tincture is taken one teaspoon three times a day during the acute period to reduce local inflammation. To do this, pour a cup of hot water over the bark and leave it for a long time, about six hours. Take it chilled.

Homeopathic remedies are also used in the complex treatment of myometritis, but they have a slightly different purpose - they are taken during recovery to restore the endometrium and myometrium, which was damaged by the inflammatory process due to an increase in the concentration of progesterone, as well as to prevent the formation of adhesions in the uterus and tubes. The main homeopathic drugs:

1. Agnus Cosmoplex C is a combined homeopathic remedy that affects all disorders of regulatory processes in the body. And also due to the rich herbal composition has an anti-inflammatory effect with tropism to the genitourinary system. This allows using the drug as an additional therapy for myometritis, which regulates the violation of the structure of the uterine wall and restores the structure with the prevention of the development of adhesions. Agnus Cosmoplex C is available in the pharmacological form of rectal suppositories and is dosed one suppository twice a day after hygiene procedures. Side effects are not common, but there may be stool disorders, dyspeptic phenomena and allergic reactions, as well as local reactions in the form of itching, burning. During pregnancy, it can be used on the recommendation of a doctor.
2. Arnica-Heel is a combined homeopathic remedy that is most often used to treat sluggish chronic myometritis, which is accompanied by a long-term subfebrile temperature. Arnica-Heel is available in the pharmacological form of homeopathic drops and is dosed 10 drops an hour after meals. Precautions - patients with an allergy to tomatoes should take the drug carefully. Side effects have not been identified.
3. Petroleum is a combined homeopathic remedy that is most often used to treat sluggish chronic myometritis caused by the use of spirals during long-term trauma to the myometrium. The drug has a healing effect, which accelerates the process of myometrium regeneration. Petroleum is available in the pharmacological form of homeopathic granules and drops, dosed three granules 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 to drink water. Side effects are rare. Perhaps a slight increase in abdominal pain, then it is necessary to increase the dose to five drops.
4. Sulfur is a homeopathic remedy of natural inanimate origin. The drug has a healing, antibacterial and regenerating effect, which has a good effect on the restoration of the myometrium and prevents the development of chronicity of the process. The drug is available in the pharmacological form of homeopathic granules and drops, dosed three granules 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 to drink water. Side effects are not common, but stool disorders, dyspeptic phenomena and allergic reactions may occur. Precautions - the drug cannot be used in acute processes in the uterus, it is better to prescribe it after a course of antibiotic therapy.

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Prevention

Prevention of myometritis is non-specific - these include regular examinations by a gynecologist, timely treatment when abdominal pain occurs, and timely treatment of chronic foci of infection. Specific prevention of myometritis concerns mainly the postpartum period and consists of prescribing antibiotics after a cesarean section or other surgical intervention on the uterus.

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Forecast

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

Myometritis is a common pathology that is a complication of the postpartum period and poses a potential threat not only to the reproductive function of a woman, but also to her life. But there is myometritis that is caused by other reasons, so it is necessary to know the main symptoms in order to start treatment in time. It is necessary to monitor your health, especially women who will all become mothers in the future, and more than once, so you need to take care of yourself.