The inside of the uterus is lined with squamous cell epithelium. This is a mucous membrane that consists of two layers. The outermost layer, the basal layer, is always present. The inner layer is renewed every month. Sometimes the mucous membrane in the uterus becomes inflamed. We call this endometritis or inflammation of the uterine lining. Symptoms include pain in the uterus, especially when pressed, a foul-smelling discharge and fever. When this occurs during the postpartum period, we call it puerperal fever or endometritis puerperalis. It is important to treat this. In the past, puerperal fever was often fatal.
Endometritis, what is that?
The name endometritis should not be confused with endometriosis. Most women have heard of endometriosis: uterine lining that is also found in places other than just the uterus. But endometritis is something completely different. It does concern the uterus and the mucous membrane there: an inflammation of the uterine lining.
Sometimes metritis also means endometritis. Actually, metritis is an inflammation of the muscle layers. Yet, metritis is sometimes colloquially used for endometritis. This can sometimes cause confusion.
The womb
Women have a uterus. This is a hollow organ in which it is possible to implant and raise a fertilized egg. The uterus is lined on the inside with squamous epithelium. These are cells that lie flat on top of each other and are not keratinized (hardened). Glands keep this epithelium moist. We also call this the uterine lining. The uterine lining consists of two layers. The outer layer is the basal layer and is always present. The inner layer is the functional layer and thickens around ovulation and is shed during menstruation. A fertilized egg implants in the uterine lining. The uterine lining can become inflamed, causing endometritis.
Causes
Endometritis, what causes it? The most common cause is an infection with a bacteria. Rarely does this bacteria simply enter the uterus. After all, the monthly menstruation cleanses the uterus. This ensures that bacteria from outside can rarely spontaneously enter the uterus. This is often caused by an operation or procedure such as curettage or a caesarean section. Bacteria can enter the uterus through these procedures. Sometimes it occurs after the insertion of an IUD. Bacteria can also enter the uterus during childbirth.
Puerperal endometritis
Puerperal endometritis involves the same inflammation of the uterine lining, but caused by childbirth. In principle, the symptoms and the treatment are the same, but this name indicates that it specifically concerns an inflammation caused by childbirth by means of, for example, a caesarean section or another aid. In the past, this was common and was called puerperal fever. Hygiene during childbirth left much to be desired. Childbed fever could be fatal. Fortunately, this is rarely the case nowadays. Puerperal endometritis still occurs in 1 in 50 deliveries, but is easily treatable. The midwife or maternity assistant will carefully check the new mother for the presence of endometritis during the first week after delivery.
Symptoms
How do you recognize endometritis? A fever develops. If this happens after delivery, fever will develop during the postpartum period, around the third to fourth day after delivery. Immediately after delivery there is sometimes already an increase: the body temperature is then around 38 degrees instead of 37. Pain occurs in the uterus, which is especially painful when pressure is applied to it. Pain in the lower abdomen also occurs. In addition, the discharge may start to smell bad. Headaches also sometimes occur.
Sometimes the symptoms are not immediately recognized. Abdominal pain or uterine pain can also be caused by another cause. After-pains are also common during the postpartum period. This can cause severe abdominal pain. However, after-effects do not include smelly discharge and fever. When a fever occurs, this is always a sign that there is an infection/inflammation. Take these complaints seriously!
Therapy
Did you know that endometritis can be fatal? In the past, women sometimes died in childbirth from puerperal fever, or endometritis. They had contracted an inflammation that continued to spread without treatment. That is why it is important to treat endometritis. After the birth, the midwife or maternity assistant will always take the temperature of the maternity woman (the woman who has recently given birth). This will happen every day during the maternity period. When the body temperature is elevated, an attempt will sometimes be made to lower it with paracetamol. If the temperature remains high or rises even more, it is necessary to start antibiotics. These kill the bacteria. An antibiotic treatment must always be completed completely so that all bacteria are killed. If a treatment is stopped halfway through, the strongest bacteria can survive and continue to reproduce. Moreover, this also creates resistance (insusceptibility to antibiotics) in the new generation of bacteria. Antibiotics are therefore becoming less and less effective.
