ENDOMETRITIS

MIDWIFERY SUBJECT FOR

CORE CORSE

R.N. Zainab Neamat Jumaah

What is endometriosis?
 DEFINITION

Endometritis is an inflammation or irritation

of the lining of the uterus (the
endometrium).
It is not the same as Endometriosis.
A reproductive system A reproductive system with
with growth of
Endometritis Endometriosis
Causes
Endometritis is caused by an infection in the uterus. It can be due to
chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal
bacteria. It is more likely to occur after miscarriage or childbirth. It is
also more common after a long labor or C-section.

The risk of Endometritis is higher after having a pelvic procedure that

is done through the cervix. Such procedures include:
D&C
Endometrial biopsy
Hysteroscopy
Placement of an intrauterine device (IUD)
Endometritis can occur at the same time as other pelvic infections.
Symptoms :
Abdominal distension
Abnormal vaginal bleeding
Abnormal vaginal discharge
-increased amount
-unusual color , consistency or odor
Discomfort with bowel movement (including
constipation)
Fever( range from 37.8 to 40 C)
General discomfort, uneasiness, or ill feeling (malaise)
Pain in lower abdomen or pelvic region (uterine pain)
Exams and Tests
The health care provider will perform a physical exam with
a pelvic exam. the uterus and cervix may be tender and
the bowel sound may be decreased. Patient may have
cervical discharge.
The following tests may be performed:
Cultures from the cervix for chlamydia, Gonorrhea, and
other organisms
Endometrial Biopsy
ESR (Sedimentation Rate)
Laparoscopy
WBC (White Blood Count)
Wet Prep (microscopic exam of any discharge)
TREATMENT
Treatment with antibiotics is important to treat the
infection and prevent complications.
Complicated cases those occurring after childbirth or
involving severe symptoms may require the patient to be
admitted to hospital.
Intravenous antibiotics are usually needed ,followed by
antibiotics taken by mouth.
Rest and hydration are important.

Treatment for sexual partners and appropriate use of

condoms throughout the course of treatment are
essential.
Possible Complications
Infertility
Pelvic peritonitis (generalized pelvic infection)
Pelvic or uterine abscess formation
Septicemia
Septic Shock
Prevention
Endometritis caused by sexually transmitted infections
can be prevented by:
Early diagnosis and complete Treatment of sexually
transmitted infections (STIs) in the patient and all
sexual partners.
Following safer sex practices, such as using condoms.
The risk of Endometritis is reduced by careful, sterile
techniques used by appropriate providers in performing
deliveries , Abortions
IUD placement and other Gynecological Procedures.

Women having a C-section may have antibiotics before

the procedure to prevent infections.
Acute Endometritis
Acute Endometritis is characterized by infection. The organisms most
often isolated 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 Gentamycin IV antibiotic treatment.
In certain populations, it has been associated with mycoplasma
Genilarium and PID.
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 , Neisseria Gonorrhea, Streptococcus
Agalactiae (Group B Streptococcus), Mycoplasma
Hominis, tuberculosis , and various viruses.
Most of these agents are capable of causing chronic (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.
Nursing Care Plan
A Woman with Endometriosis
Angela Hall is a 31-year-old married accountant, who
relates a history of severe dysmenorrhea and
menorrhagia, a feeling of pelvic heaviness and pain that
radiates down her thighs.
Because of her discomfort, her husband has complained
about the quality of their sex life and has expressed
concerns about their plans for having children. Mrs. Hall
reports being so tired she doesnt care whether she has
sex or not, and, in fact, would really prefer not to: Sex
hurts so much, I just cant stand it. Endometriosis is
suspected, and a diagnostic laparoscopy has been
scheduled.
ASSESSMENT
Christine Brigham, RN, NP, interviews Mrs. Hall and
makes the following assessments:
BP 110/70, P 68, R 18, T (36.7C).
Mrs. Halls weight is (59 kg) and within normal limits
for her height.
Review of laboratory findings indicate a hemoglobin
level of 9.8 g/dL (normal range: 12 to 16 g/dL) and a
hematocrit of 33.1% (normal range: 35% to 45%).
Physical examination reveals pelvic tenderness on
manipulation of the cervix, and small masses that are
palpable on abdominal/pelvic examination.
DIAGNOSIS
Chronic pain, related to endometrial pelvic implants.

Anxiety, related to effect of endometriosis on fertility.

Deficient knowledge, related to diagnosis and treatment

options.

Ineffective sexuality patterns, related to the

manifestations of endometriosis.
EXPECTED OUTCOMES
Develop effective self-care measures to deal with the
pain and discomfort.

Verbalize decreased anxiety.

Demonstrate understanding of the disease and

treatment options.

Verbalize an improvement in sexual functioning and a

decrease in interpersonal stress between herself and her
husband.
PLANNING AND IMPLEMENTATION
Identify the location, type, duration, and history of the
pain.
Recommend analgesics and heat therapy.
Provide information on biofeedback, relaxation, and
imagery to lessen pain.
Discuss with Mr. and Mrs. Hall the causes of
endometriosis and its manifestations.
Encourage the Halls to discuss their feelings about the
effect of the disease on their sex life, lifestyle, and
fertility.
Refer the couple to the local mental health center if
appropriate.
EVALUATION
Two years after the initiation of treatment, Mr. and Mrs. Hall
have become parents of a baby girl.
Mrs. Hall states that the discomfort and other manifestations of
endometriosis have eased.
Relaxation and imagery have effectively minimized her pain and
brought about improvement in her function as wife, mother,
and sexual partner.
Counseling has improved the interpersonal and sexual relations
between the Halls.
Dietary management has improved her anemia, although the
menorrhagia persists.
The Halls are trying to have a second child, understanding the
advantages of rapid succession of pregnancies. They will be
followed in the nursing clinic and referred to an infertility clinic
if conception does not occur within 1 year.
THANK YOU