Uterine Artery Embolization
John C. Petrozza in Uterine Fibroids, 2020
The other most common adverse events include: Endometritis, presenting as pelvic pain with watery vaginal discharge, fever and/or leukocytosis that occur from days to weeks after the procedure and may be due to infectious or noninfectious causes.Fibroid infection from bacterial colonization of embolized fibroid tissue either through blood or vaginal ascent of pathogens. Symptoms and signs include abdominal or pelvic pain, fever and/or leukocytosis.Uterine infection, possibly as a result of necrosis of all or part of the uterus, again manifest with abdominal or pelvic pain, vaginal discharge, fever and/or leukocytosis.Fibroid expulsion, with detachment of a devascularized fibroid from the uterine wall and subsequent transvaginal passage. This is most common among submucosal fibroids with a narrow attachment. Fibroid expulsion is associated with uterine contractions, abdominal pain, fever, nausea, vomiting and vaginal bleeding or discharge.
Obstetrics and gynaecology
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding the intrauterine contraceptive device (IUCD) true or false? A dislodged IUCD may migrate to a subphrenic region.Endometritis is usually detectable on ultrasound.The Mirena coil is more easily visible on ultrasound than the Lippes loop and Copper 7 devices.A correctly positioned IUCD should lie within 10–15 mm of the apex of the fundus.Perforation of the uterus by IUCD usually occurs 24–72 hours after the time of insertion.
Postpartum Care
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
Antibiotic treatment that includes coverage for aerobic and anaerobic pathogens likely to be causing endometritis should be administered promptly. The gold standard for the treatment of postpartum endometritis is the combination of clindamycin 900 mg IV every 8 hours plus gentamicin 5 mg/kg IV every 24 hours [114]. The combination of ampicillin-sulbactam (3 g every 6 hours) and gentamicin (1.5 mg/kg every 8 hours) is as effective and well tolerated as a combination regimen using clindamycin plus gentamicin and therefore could be used in case of clindamycin resistance [129]. The treatment should be continued until the woman is afebrile for (usually) 24–48 hours and the pelvic pain disappears. In case of persistent fever for more than 48 hours of antibiotic therapy, the addition of ampicillin or penicillin to the regimen can be an effective approach because of the presence of resistant organisms, such as enterococci, in about 20% of cases [130]. If the woman has not improved despite the adjustment of the initial antibiotic therapy, other etiologies of fever should be considered. Ultrasound may demonstrate the retained tissue fluid collection such as pelvic abscess or infected hematoma [131]; computed tomography (CT) or magnetic resonance imaging are helpful if septic pelvic thrombophlebitis or ovarian vein thrombosis is suspected. For women with negative imaging, the likelihood of a drug fever should be considered [132].
Retained pregnancy tissue after miscarriage is associated with high rate of chronic endometritis
Published in Journal of Obstetrics and Gynaecology, 2022
Dana B. McQueen, Kruti P. Maniar, Anne Hutchinson, Rafael Confino, Lia Bernardi, Mary Ellen Pavone
Chronic endometritis is an inflammatory condition of the uterus characterised by plasma cell infiltrate and endometrial stromal changes. These stromal changes include spindling of cells, oedema, breakdown, pigment deposition, areas of hypercellularity, and presence of inflammatory cells other than plasma cells (lymphocytes, eosinophils, neutrophils and histiocytes). In a manuscript published by our group in 2021, we established that endometrial stromal cell changes are essential to the diagnosis of chronic endometritis. While healthy controls may have rare plasma cells identified within their endometrium, in our study no controls had both plasma cells and endometrial stromal cell changes. In contrast, women with a history of RPL frequently had both plasma cells and endometrial stromal cell changes on endometrial biopsy. Currently, known risk factors for chronic endometritis include a history of pelvic inflammatory disease, intrauterine polyps and fibroids (Wasserheit et al. 1986; Crum et al. 2011). The aetiology for increased chronic endometritis among women with RPL is unknown; however, we hypothesise that retained pregnancy tissue (RPT) following miscarriage may be a risk factor.
A review of post-caesarean infectious morbidity: how to prevent and treat
Published in Journal of Obstetrics and Gynaecology, 2018
Rebecca C. Pierson, Nicole P. Scott, Kristin E. Briscoe, David M. Haas
Puerperal infection is a significant cause of morbidity and mortality in postpartum women worldwide (Kassebaum et al. 2014). Puerperal infection increases length of hospital stay and healthcare costs. One of the major risk factors for postpartum infection is caesarean delivery (CD). Post-caesarean infection can be separated into two sub-groups: surgical site infection (SSI) and endometritis. Surgical site infection refers to infection of the skin and subcutaneous tissue at the location of the incision. Endometritis or endomyometritis refers to infection of the uterine corpus, endometrium and myometrium. According to a large retrospective study in the United States, the cost per patient of readmission and treatment for SSI and endometritis was $3529 USD and $3956 USD, respectively (Olsen et al. 2010). In addition to healthcare costs, there is the potential for impact on initiation and continuation of breastfeeding. In 2012, approximately 22.9 million CDs were performed worldwide (Molina et al. 2015); it is imperative to understand the disease process and prevention and management strategies.
Nrf2/HO-1 pathway is involved the anti-inflammatory action of intrauterine infusion of platelet-rich plasma against lipopolysaccharides in endometritis
Published in Immunopharmacology and Immunotoxicology, 2022
Peng Zhang, Dan Li, Zongzhi Yang, Pingping Xue, Xiaoqiang Liu
The uterus, specifically the endometrium lining of the uterus, plays significant roles in normal reproductive cycles, implantation and placentation, as well as supporting a healthy fetus until parturition [1]. According to statistics, 15% of infertile women who undertook in vitro fertilization cycles suffered from endometritis, and the prevalence of endometritis was as high as 42% in patients with recurrent implantation failure [2]. Accurate diagnosis for endometritis is still a challenging task under a conventional histopathological analysis [3]. Endometritis represents a persistent inflammation of the endometrial mucosa induced by bacterial pathogens, such as Enterobacteriaceae, Enterococcus, Streptococcus, Staphylococcus, Mycoplasma, and Ureaplasma [4]. Lipopolysaccharide (LPS), a main component of the outer membrane of bacteria, is the pathogen-associated molecular pattern to the innate immune system, which can act as a competent stimulator in the immune system [5]. Therefore, LPS was used in this study to establish both cell and animal model with endometritis.
Related Knowledge Centers
- Fever
- Inflammation
- Pelvic Inflammatory Disease
- Cervix
- Infection
- Endometrium
- Uterus
- Vaginal Discharge
- Vaginal Bleeding
- Postpartum Infections