ENDOMETRITIS

SA KHUN, SHAMOON ANISHA

ENDOMETRIUM
 It is the lining of uterus.it consists of columnar epithelium and stroma.it has two
layers;
1)functional built after end of menstruation during the first part of the previous
menstrual cycle. It sheds during menstruation.
2)basal layer is not shed during menstrual cycle and functional layer develops from it.
 ENDOMETRITIS
It is inflammation of the lining of the uterus. Commonly occurs after giving birth or
also in non-pregnant women.
In addition to endometrium, inflammation may involve myometrium and occasionally
parametrium.
CAUSES OF ENDOMETRITIS
 Endometritis is caused by infection in the uterus.It can be due to;
-Chlamydia
-Tuberculosis
-Gonorrhea
-Mix. of normal vaginal bacteria.
It is most likely to occur after miscarriage or childbirth or after C-section.
 It can be transmitted through following medical procedures;
-Hysteroscopy
-Placement of an Intra Uterine Device(IUD)
-Uterine scrapping
SYMPTOMS
 Dysmenorrhea
 Dyspareunia
 Abnormal vaginal discharge
-increased amount
-unusual color,consistency,color
 Discomfort with bowel movement(including constipation).
 Fever(range from 37.8 to 40C)
 General discomfort, uneasiness, or ill feeling(malaise).
 Pain in lower abdomen or pelvic region.
 Pain is typically chronic and crampy.
 Infertility.
Exams and Test
◦ 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
 It is characterized by infection.The organisms most often isolated are
because of compromised abortions, delivery,medical instrumentation
and retention of placental fragments.
 Histologically; Neutrophilic infiltration of the endometrial tissue is
present during the acute endometritis.
 Clinical presentation include typical high fever and purulent vaginal
discharge.
 Menstruation after acute endometritis is excessive.
 Most often caused by Staphylococci, Streptococci or N.gonorrheae.
CHRONIC ENDOMETRITIS
 Characterized by the presence of the plasma cells in the stroma.
 Lymphocytes, eosinophills and even lymphoid follicles can be seen but in the absence of plasma cells
are not enough for a histologic diagnosis.
 The most common organisms are;
-Neisseria gonorrheae
-Chlamydia
-Streptococcus Agalactiae
-Tuberculosis
-Mycoplasma
-Various viruses
Patients suffering from chronic endometritis may have an underlying cancer of the
cervix or the endometrium.
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