Black object appears after two months of medical abortion

Although a uterine curettage surgery with drugs can end a child's life, it can also cause great harm to the woman's body. Especially for women who have undergone a uterine curettage surgery, it is best not to get pregnant again within two years, otherwise it will affect the next fetus. If you don’t take good care of your body after a uterine curettage, you will not only suffer from postpartum diseases, but in severe cases it will also make it difficult for you to give birth in the future, so you must take good care of your body.

Causes

1. Pregnancy and childbirth

Puerperal infection and septic abortion are common causes of acute endometritis. A small amount of fetal membrane or placenta remaining in the uterine cavity after delivery, or incomplete uterine involution at the site of placental attachment, can cause chronic endometritis.

2. Uterine surgery and intrauterine contraceptive device placement

Intrauterine surgical procedures, especially informal induced abortions, can lead to bacterial invasion and infection. Long-term stimulation from an intrauterine contraceptive device can cause chronic endometritis.

3. Not paying attention to personal hygiene

This disease is also likely to occur during sexual intercourse during menstruation and with the opposite sex who has a sexually transmitted disease.

4. Intrauterine lesions

Endometrial polyps, submucosal fibroids, or necrosis of endometrial cancer can cause endometrial infection.

The ascending infection of cervicitis and vaginitis, and the downward spread of fallopian tube and ovarian inflammation can all lead to the occurrence of endometritis.

6. Low estrogen levels

After menopause or post-menopause, the estrogen level in the body decreases, the acidity in the vagina decreases, and the cervical mucus plug decreases. The body's physiological barrier function weakens, making it easier for bacteria to invade.

Clinical manifestations

1. Chronic endometritis

1. Symptoms

(1) Pelvic pain: Pain in the lower abdomen and lumbar pain during the menstrual interval. Some patients may not have any symptoms.

(2) Increased vaginal discharge

Caused by increased secretion of endometrial glands. It is usually thin, watery, light yellow, and sometimes bloody. Senile endometritis presents as purulent leucorrhea, which often contains a small amount of blood. When there is pyometra, the discharge is purulent and has a foul odor.

(3) Menorrhagia: Menstrual periods are regular but the amount of menstrual blood doubles and the bleeding period is significantly prolonged. Irregular bleeding is less common.

(4) Dysmenorrhea is more common in nulliparous women, but severe dysmenorrhea is rare. It may be caused by excessive thickening of the endometrium, which hinders normal tissue degeneration and necrosis, and stimulates excessive spasmodic contractions of the uterus.

The uterus may be enlarged and tender; the parauterine tissue may be thickened and tender. In mild inflammation, no abnormalities may be found during bimanual examination. When uterine pyometra occurs, the uterus will be enlarged, spherical, soft and tender. Speculum examination can reveal that the cervix is ​​discharging bloody pus with a foul odor.

(ii) Acute endometritis

1. Symptoms

Mild fever, lower abdominal pain, increased leucorrhea, sometimes bloody, and with a foul odor if it is an anaerobic infection. The symptoms of acute endometritis that occurs after delivery or abortion are more severe, while endometritis caused by other reasons is mostly mild.

2. Physical signs

The uterus may be mildly tender during examination. If the condition is not controlled in time, it will further cause uterine myositis, acute salpingitis, pelvic inflammatory disease, etc. The patient's body temperature will rise significantly, reaching above 39°C, and there will be obvious tenderness in the lower abdomen.

examine

1. Vaginal examination

Whenever possible, uterine fluid should be sent for bacterial culture and drug sensitivity testing, and smear testing should be performed for reference of the drug to be used. Speculum examination showed a large amount of purulent or foul, bloody and smelly secretions overflowing from the uterine opening. Cervical motion tenderness on bimanual examination. The uterus is swollen due to congestion and edema, and is soft and tender.

2. Blood routine examination for inflammatory response indicators

The total white blood cell count and neutrophil count increased, and inflammatory indicators such as C-reactive protein and erythrocyte sedimentation rate increased.

3. Diagnostic curettage

It can identify the cause of the disease and rule out malignant lesions. Inflammation should be controlled for 3 days before surgery, and antibiotics should continue to be given after surgery. The operation should be gentle during the operation because the infected uterine wall is fragile and can easily cause uterine perforation. The endometrium of senile endometritis is thin, so more care should be taken when scraping it. Endometritis after miscarriage may leave residual embryonic tissue, which should be carefully and thoroughly scraped out, which can often play a therapeutic role at the same time.

4. Pathological examination

The cause can be identified. There are a large number of plasma cells and lymphocytes infiltrating in the intimal stroma. In patients with prolonged inflammation, proliferation of fibroblasts and capillaries may be seen.