Infections of the uterus and pelvis Flashcards
What is endometritis?
• Infection confined to the uterus- if untreated it commonly spreads to the pelvis
• Often the result of instrumentation in the uterus or a complication of pregnancy
Caused by
o Chlamydia
o Gonorrhoea
o E.Coli
o Staphylococci
o Clostridia
Common after C-section, miscarriage or abortion (esp if products of conception are retained)
How does endometritis present?
persistent and heavy vaginal bleeding, usually with pain
uterus is tender and cervical os is commonly open
Severe sepsis can ensue
What are the investigations for endometritis?
vaginal and cervical swabs with FBC- pelvic USS is not reliable
What is the treatment for endometritis?
broad-spectrum antibiotics -evacuation of retained products of conception (ERPC) is then performed if symptoms do not subside or if products can be seen on USS
What is pelvic inflammatory disease (PID)?
• Pelvic inflammatory disease (PID) or salpingitis- endometritis usually coexists
incidence is increasing with 2% of women affected in their lifetime
More common in women with STI risk factors
• COCP is partly protective, as is IUS- almost never occurs in the presence of a viable pregnancy
What are the causes of PID?
ascending infection of bacteria in the vagina and cervix
can be due to descending infection from local organs (appendix)
• Spread from previously asymptomatic STIs to pelvis is usually spontaneous- result of uterine instrumentation and/or complication of childbirth/miscarriage
Which organisms cause PID?
• Infection is frequently polymicrobial o Chlamydia (60%) and gonorrhoea are principal STI causes o Endometritis and uni/bilateral salpingitis and parametritis occur o Ovaries are rarely involved
What are the symptoms of PID?
bilateral lower abdominal pain with deep dyspareunia
abnormal vaginal bleeding or discharge
May present later with sub fertility or menstrual problems
Tachycardia and high fever
signs of lower abdominal peritonism with bilateral adnexal tenderness and cervical excitation
What is Fitz-Hugh-Curtis?
Perihepatitis
causes RUQ pain due to adhesions between liver and anterior abdominal wall- easily visible at laparoscopy
What are the investigations for PID?
o Endocervical swab- taken for chlamydia and gonorrhoea, blood cultures if fever
o WBC & CRP- may be raised
o Pelvis USS- excludes abscess or ovarian cyst
o Laparoscopy- fimbrial biopsy and cultures is gold standard
What is the treatment for PID?
parenteral cephalosporin (IM ceftriaxone), followed by doxycycline and metronidazole or ofloxacin and metronidazole
febrile patients should be admitted for IV therapy
pelvis abscess may require draining
What are the complications of PID?
many women develop tubal obstruction and subfertility, chronic pelvic infection or chronic pelvic pain
ectopic pregnancy is also x6 more likely after pelvic infection
What is chronic PID?
result of non-treatment, inadequate treatment of acute PID or reinfection following failure to treat sexual partners
• There are dense pelvic adhesions- fallopian tubes obstructed and dilated with fluid (hydrosalpinx) or pus (pyosalpinx)
What are the common symptoms of PID?
o Chronic pelvic pain o Dysmenorrhoea o Deep dyspareunia o Heavy and irregular menstruation o Chronic vaginal discharge o Subfertility abdominal and adnexal tenderness and fixed retroverted uterus
What are the investigations for chronic PID?
transvaginal USS may reveal fluid collections within the fallopian tubes or surrounding adhesions- laparoscopy is the best diagnostic tool- culture is often negative
