Uteritis is one of the inflammatory diseases of the pelvic reproductive organs and a common condition in women. The inflammation can be confined to a single area or affect multiple areas simultaneously. Clinically, the latter scenario is more frequently observed. Acute inflammation may lead to severe consequences such as diffuse peritonitis, sepsis, and even septic shock.

bubble_chart Etiology

Unhygienic menstruation, intercourse during menstruation, or chaotic sexual activity can introduce pathogenic bacteria from the outside or the vagina and cervix into the uterine cavity.

bubble_chart Pathological Changes

In grade I infection, the inner membrane only shows congestion, edema, and infiltration of polymorphonuclear leukocytes and round cells. In severe infections, pus may form and undergo transformation, with extensive necrosis that can extend to the underlying muscle layer, leading to uterine myositis.

bubble_chart Clinical Manifestations

The onset is relatively acute, with aversion to cold or even shivering, fever (38–40°C), rapid pulse, general weakness, sweating, severe lower abdominal pain, bearing-down sensation, and lumbar soreness. There is a large amount of bloody, purulent, or watery leucorrhea with a foul odor. In cases of postpartum infection, the lochia appears muddy in color.

Signs: The patient exhibits tenderness in the lower abdomen. Speculum examination reveals a large amount of purulent or foul-smelling bloody discharge overflowing from the uterine os. During bimanual examination, there is cervical motion tenderness. The uterine body is enlarged due to congestion and edema, soft, and markedly tender. Laboratory tests show an increase in total white blood cell count and neutrophils.

Based on the medical history and clinical manifestations, the diagnosis is straightforward. During speculum examination, it is advisable to collect uterine cavity discharge for bacterial culture and sensitivity testing, along with smear examination for bacterial identification, to guide medication. Repeated vaginal examinations should be avoided to prevent the spread of infection.

bubble_chart Treatment Measures

(1) Bed rest: Adopt a semi-recumbent position to facilitate the discharge of uterine cavity secretions. The diet should consist of easily digestible, high-calorie semi-liquid meals. Bowel movements must be kept regular. Apply cold compresses to the lower abdomen or use hot water bags, fried salt, Kanli Coarse Powder, Chinese medicinals, etc., for heat therapy (see previous treatment principles for details).

(2) Infection control: Generally, administer penicillin 4–8 million U intravenously per day and gentamicin 240,000 U intravenously per day until symptoms completely disappear, then switch to intramuscular injections for about 1 week before discontinuing. Metronidazole 0.4g orally, three times daily, may be added concurrently. Alternatively, select potent antibiotics based on symptoms, secretion characteristics, bacterial culture, and drug sensitivity.

(3) Symptomatic treatment: Take ergot liquid extract 2ml or motherwort herb liquid extract 4ml orally, three times daily for 3 days to promote uterine contractions and expel infected uterine cavity secretions.

Intravenous fluids should be administered to patients with high fever.