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 A reproductive system
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
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.
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
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 doesn’t care whether she has sex or not,
and, in fact, would really prefer not to: “Sex
hurts so much, I just can’t stand it.”
Endometriosis is suspected, and a diagnostic
ASSESSMENT
• Christine Brigham, RN, NP, interviews Mrs. Hall
and makes the following assessments:
BP 110/70, P 68, R 18, T (36.7°C).
Mrs. Hall’s 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
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
THANK YOU