Infectious endometritis: systematic analysis of risk factors, clinical manifestations, and treatment strategies
Keywords:
DIAGNÓSTICO; ENDOMETRITIS; FACTORES DE RIESGO; SALUD REPRODUCTIVA; TERAPÉUTICA., DIAGNOSIS; ENDOMETRITIS; RISK FACTORS; REPRODUCTIVE HEALTH; THERAPEUTICS., DIAGNÓSTICO; ENDOMETRITE; FATORES DE RISCO; SAÚDE REPRODUTIVA; TERAPÊUTICA.Abstract
Introduction: infectious endometritis is an inflammation of the endometrium caused by aerobic and anaerobic microorganisms, with significant impact on female reproductive health.
Objective: to analyze risk factors, clinical manifestations, and therapeutic strategies for infectious endometritis through a systematic literature review.
Methods: a systematic review of the scientific literature was conducted across multiple databases. The search employed an algorithm combining keywords and Boolean operators to identify relevant sources. Selected studies, after applying inclusion and exclusion criteria, were critically analyzed considering recency, methodological quality, and thematic relevance, and integrated into the final synthesis of the review.
Development: reviewed studies identify sexually transmitted infections, cesarean delivery, abortions, and invasive gynecological procedures as key risk factors. Diagnosis relies on clinical assessment, laboratory tests, and ultrasound, with hallmark signs including fever, uterine tenderness, and abnormal lochia. Acute cases require intravenous antibiotics followed by oral therapy, while chronic endometritis demands prolonged, culture-guided regimens. Doxycycline and combinations with metronidazole or ciprofloxacin show efficacy. Prevention focuses on appropriate STI management and sterile techniques during obstetric procedures.
Conclusions: infectious endometritis can be prevented and effectively treated through early diagnosis and personalized therapies. Pathogen diversity necessitates tailored approaches and standardized protocols. Longitudinal studies evaluating reproductive outcomes and optimizing public health prevention are needed.
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1. Singh N, Sethi A. Endometritis - Diagnosis,Treatment and its impact on fertility - A Scoping Review. JBRA Assist Reprod [Internet]. 2022 Aug 4 [Citado 20/08/2025]; 26(3): 538-546. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35621273/
2. Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T. Endometritis: new time, new concepts. Fertil Steril [Internet]. 2018 Aug [Citado 20/08/2025]; 110(3):344-350. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29960704/
3. Klimaszyk K, Svarre Nielsen H, Wender-Ozegowska E, Kedzia M. Chronic endometritis - is it time to clarify diagnostic criteria? Ginekol Pol [Internet]. 2023 [Citado 20/08/2025]; 94(2):152-157. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36511457/
4. Yan X, Jiao J, Wang X. The pathogenesis, diagnosis, and treatment of chronic endometritis: a comprehensive review. Front Endocrinol (Lausanne) [Internet]. 2025 Jun 12 [Citado 20/08/2025]; 16: 1603570. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40575265/
5. Kalaitzopoulos DR, Catena U, Schwartz AK, Schoretsanitis G, Leeners B, Drakopoulos P, Samartzis N, et al. Chronic Endometritis and Endometriosis: Two Sides of the Same Coin? Reprod Sci [Internet]. 2025 Feb [Citado 20/08/2025]; 32(2): 474-487. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39821822/
6. Zeng S, Liu X, Liu D, Song W. Research update for the immune microenvironment of chronic endometritis. J Reprod Immunol [Internet]. 2022 Aug [Citado 20/08/2025]; 152: 103637. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35576684/
7. Darici E, Blockeel C, Mackens S. Should we stop screening for chronic endometritis? Reprod Biomed Online [Internet]. 2023 Jan [Citado 20/08/2025]; 46(1): 3-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36075850/
8. Yan X, Jiao J, Wang X. Inflammatory mechanisms and therapeutic advances in chronic endometritis. Front Immunol [Internet]. 2025 Sep 5 [Citado 20/08/2025]; 16: 1616217. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40977728/
9. Margulies SL, Flores V, Parkash V, Pal L. Chronic endometritis: A prevalent yet poorly understood entity. Int J Gynaecol Obstet [Internet]. 2022 Jul [Citado 20/08/2025]; 158(1):194-200. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34605024/
10. Hillier SL, Bernstein KT, Aral S. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. J Infect Dis [Internet]. 2021 Aug 16 [Citado 20/08/2025]; 224(12 Suppl 2):S23-S28. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34396398/
11. Torres LJ, Rodríguez Ortiz JA. Factores de riesgo para Endometritis Puerperal en pacientes que asisten para terminación del embarazo en el hospital Simón Bolivar entre Enero 2007 a Diciembre 2013. Rev. chil. obstet. ginecol. [Internet]. 2017 Feb [citado 2026 Feb 10]; 82(1): 19-29. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-75262017000100003&lng=es.
12. Mallquí F. FACTORES DE RIESGO ASOCIADOS A ENDOMETRITIS PUERPERAL EN PACIENTES ATENDIDAS EN EL HOSPITAL NACIONAL HIPÓLITO UNANUE- EL AGUSTINO. DURANTE LOS AÑOS 2016-2017 [Tesis]. Universidad de San Martín de Porres; 2020 [Citado 20/08/2025]. Disponible en: https://alicia.concytec.gob.pe/vufind/Record/USMP_1e959511049a8858076a89d540ff901d/Details
13. Chaverri G. ENDOMETRITIS POSTPARTO. Revista Médica Sinergia [Internet]. 2016 [Citado 20/08/2025]; 1(12): 21-25. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7070370
14. Grandes A. FACTORES DE RIESGO Y COMPLICACIONES DE ENDOMETRITIS PUERPERAL. HOSPITAL CARLOS ANDRADE MARÍN. QUITO 2016 - 2020 [Tesis]. [Riobamba]: UNIVERSIDAD NACIONAL DE CHIMBORAZO; 2021 [Citado 20/08/2025]. Disponible en: http://dspace.unach.edu.ec/handle/51000/8148
15. Mayo Clinic. Enfermedad inflamatoria pélvica [Internet]. Mayo Clinic; 2022 [citado el 31 de julio de 2024]. Disponible en: https://www.mayoclinic.org/es/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594
16. Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ. Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review. Obstet Gynecol [Internet]. 2015 Apr [Citado 20/08/2025]; 125(4):789-800. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25751198/
17. Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis [Internet]. Cochrane Library; 2015 [citado el 31 de julio de 2024]; (2): CD001067. Disponible en: https://doi.org/10.1002/14651858.CD001067.pub3
18. Taylor M, Jenkins SM, Pillarisetty LS. Endometritis. StatPearls Publishing; 2023.
19. Roeckner JT, Sanchez-Ramos L, Mitta M, Kovacs A, Kaunitz AM. Povidone- iodine 1% is the most effective vaginal antiseptic for preventing post-cesarean endometritis: a systematic review and network meta-analysis. Am J Obstet Gynecol [Internet]. 2019 [Citado 20/08/2025]; 221(3): 261.e1-261.e20. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30954518/
20. Hodgetts-Morton V, Hewitt CA, Wilson A, Farmer N, Weckesser A, Dixon E, et al. Vaginal preparation with chlorhexidine at cesarean section to reduce endometritis and prevent sepsis: A randomized pilot trial (PREPS). Acta Obstet Gynecol Scand [Internet]. 2020 [Citado 20/08/2025]; 99(2): 231–9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31539171/
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