Acute and chronic endometritis
- Lesion
Infection of the endometrium follows delivery, abortion or devices; neutrophils mark the acute form and plasma cells the chronic one.
What it is
The endometrium resists infection because it is shed each month, so endometritis usually needs a trigger. Acute endometritis follows delivery or abortion, especially with retained tissue, and is caused by bacteria such as group A or B streptococci and staphylococci. Chronic endometritis is defined by plasma cells in the stroma and accompanies pelvic inflammatory disease, retained products of conception, intrauterine devices and tuberculosis; it causes bleeding, pain and infertility.
Structure
- Acute: neutrophilic infiltrate, microabscesses and necrotic decidua or villi when products of conception are retained.
- Chronic: plasma cells and lymphocytes in the stroma, sometimes lymphoid follicles; glands may look out of phase and the stroma spindled.
- Tuberculous: granulomas, which form best in secretory endometrium and are often small because the lining is shed.
Step by step
- Delivery, abortion or instrumentation opens the cervix and leaves damaged tissue in the uterus.
- Bacteria from the vagina or the skin colonise the retained tissue and the raw placental bed.
- Neutrophils invade (acute endometritis); infection can extend to the myometrium and parametria and cause sepsis.
- If the trigger persists (device, retained tissue, untreated sexually transmitted infection), the infiltrate becomes chronic with plasma cells.
- Inflammation and repair can scar the lining and the tubes and reduce fertility.
Clinical notes
- Postpartum endometritis causes fever, uterine tenderness and foul lochia; it is the commonest cause of puerperal fever.
- Chronic endometritis causes irregular bleeding, pelvic pain and recurrent implantation failure or miscarriage.
- In Colombia and other regions where tuberculosis is common, genital tuberculosis should be considered in infertility with an abnormal biopsy.
Test yourself
Think of the answer, then tap the question to see it.
Which cell defines chronic endometritis?
The plasma cell in the endometrial stroma.
What usually triggers acute endometritis?
Delivery, miscarriage or abortion, especially with retained products of conception that bacteria colonise.
How does tuberculosis reach the endometrium?
By blood to the fallopian tubes first, then by extension to the endometrium, where it forms granulomas.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Pelvic Inflammatory Disease (StatPearls (NCBI Bookshelf), 2026); Chlamydia trachomatis Infection (StatPearls (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.