Endometritis - Diagnosis,Treatment and its impact on fertility - A Scoping Review

Abstract

Endometritis is defined as an infection or inflammation of the endometrium. Endometritis is of two types: acute and chronic. Acute endometritis is the symptomatic acute inflammation of the endometrium, which upon examination with a microscope shows micro-abscess and neutrophil invasion in the superficial endometrium. One of its most common manifestations is postpartum endometritis. Chronic endometritis is a silent disease usually diagnosed on the workup of secondary amenorrhoea and infertility. An important cause of chronic endometritis is tuberculosis, especially in developing nations. Chronic and acute endometritis have been associated with poor reproductive outcomes. Worse outcomes have been reported for individuals with chronic endometritis. This is a scoping review of endometritis and its impact on fertility.

Discussion issues in the treatment of chronic endometritis

“…Среди опробованных схем первой линией терапии считают доксициклин 100 мг 2 раза в день в течение 14 дней. Вторая линия включает ципрофлоксацин и метронидазол 500 мг 1 раз в сутки в течение двух недель или офлоксацин 400 мг 1 раз в сутки и метронидазол 500 мг 1 раз в сутки в течение двух недель, в резистентных случаях -миноциклин по 200 мг в сутки 12 дней, описаны также конкретные схемы в соответствии с микробиологическим профилем пациенток [30].…”

Antibiotic Recommendations After Postpartum Uterine Exploration or Instrumentation

“…Rupture of the amniotic sac allows for normal bacterial flora of the vagina and cervix to translocate into the uterus. The postpartum uterus is especially vulnerable to bacterial colonization due to the devitalized state, bleeding, and/or damaged tissue 2,14 . Postpartum endometritis is defined as a new uterine infection greater than 1 hour after delivery or greater than 2 hours after delivery with an intra-amniotic infection diagnosis within 6 weeks of delivery 15,16 .…”

“…The postpartum uterus is especially vulnerable to bacterial colonization due to the devitalized state, bleeding, and/or damaged tissue. 2,14 Postpartum endometritis is defined as a new uterine infection greater than 1 hour after delivery or greater than 2 hours after delivery with an intra-amniotic infection diagnosis within 6 weeks of delivery. 15,16 Most women present with symptoms within the first 5 days of the postpartum period.…”

High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non‐uniform endometrial echogenicity

“…1 In recent years, the impact of CE on assisted reproductive technology (ART) has come under greater scrutiny. 2 CE consists of a prolonged, continuous, mild endometrial inflammation characterized by plasma cell infiltration into the stroma area of the endometrium. 3 There is increasing evidence to suggest that CE may be a cause of recurrent implantation failure (RIF), early miscarriages, recurrent pregnancy loss, and certain obstetric complications.…”

“…2 CE patients usually have no symptoms or mild symptoms, and an efficient and relatively non-invasive means for diagnosing CE is still missing. Previously, reports on the risk factors for CE were not unified.…”