Disorder Endometritis

Definition Endometritis is an infection of the endometrium or decidua, with extension into the myometrium and parametrial tissues. Endometritis is divided into obstetric and nonobstetric endometritis. It is the most common cause of fever during the postpartum period Acute Endometritis Acute Endometritis is characterized by infection. The most causative agents are Staphylococcus aureus and Streptococcus. The most common causes of infection are believed to be because of compromised abortions, delivery, medical instrumentation, and retention of placental fragments. Chronic Endometritis Chronic Endometritis is characterized by the presence of plasma cells in the stroma. The most common causes are chronic pelvic inflammatory disease (PID), tuberculosis, and chlamydia. Patients suffering from chronic endometritis often have an underlying cancer of the cervix or endometrium. Chronic granulomatous endometritis is most often tuberculous in etiology. The granulomas are small, sparse, and without caseation. The granulomas take up to 2 weeks to develop and since the endometrium is shed every 4 weeks, the granulomas are poorly formed

Signs and symptom History Diagnosis usually is based on clinical findings.

Management Medical

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Physical Fever Lower abdominal pain Foul-smelling lochia in the obstetric population Abnormal vaginal bleeding Abnormal vaginal discharge Dyspareunia (may be present in patients with pelvic inflammatory disease [PID]) Dysuria (may be present in patients with PID) Malaise

Combination intravenous clindamycin and gentamicin administered every 8 hours has been considered the criterion standard treatment. Some studies have revealed adequate efficacy with daily dosing as well.2 Second- or third-generation cephalosporin in combination with metronidazole is another popular choice. Improvement is usually noted within 48-72 hours in nearly 90% of women. Parenteral therapy is continued until the patient has been afebrile for longer than 24 hours. Thereafter, oral antibiotics are not usually necessary. Gentamicin Garamycin Clindamycin Cleocin Cefoxitin Mefoxin Doxycycline Bio-tab Doxy Vibramycin Vibra-tabs

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Fever, usually occurring within 36 hours of delivery, in the obstetric population Lower abdominal pain Uterine tenderness Adnexal tenderness if there is an associated salpingitis Foul-smelling lochia Tachycardia

Surgical Dilatation and curettage Nursing management

vaginitis

Vaginitis is described medically as irritation and/or inflammation of the vagina. Vaginitis is a very common disease affecting millions of women each year. Bacterial - this type of infection is caused when healthy vaginal organisms are replaced by bacteria. It is referred to as bacterial vaginosis and is the most common type of vaginitis. Yeast - this type of infection is called candidiasis. It is caused by a fungus and is the second most common type of vaginitis. Protozoan - this type of infection is called trichomoniasis and it is considered a sexually transmitted disease (STD). It is the least common and comprises 3% to 5% of all vaginitis infections. Trichomoniasis - Trichomoniasis is a sexually transmitted disease that is caused by a single-cell parasite. It can cause vaginal itching, burning, and soreness of the vagina and vulva, as well as burning during urination. Many women with trichomoniasis do not develop any symptoms. Non-infectious vaginitis - This form of vaginitis is usually caused by an allergic reaction or irritation from vaginal sprays,douching, spermicidal products, soaps, detergents, or fabric softeners. It can cause burning, itching, or vaginal discharge even if there is no infection

Vaginitis symptoms may include: Change in color, odor or amount of discharge from your vagina Vaginal itching or irritation Pain during intercourse Painful urination Light vaginal bleeding

Medical The type of medication used for vaginitis treatment depends on which type you have: Bacterial vaginosis. metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) as tablets or vaginal gels or creams. Yeast infections. Yeast infections usually are treated with an antifungal cream or suppository, such as miconazole (Monistat), clotrimazole (Gyne-Lotrimin) and tioconazole (Vagistat). Yeast infections may also be treated with an oral antifungal medication, such as fluconazole (Diflucan).

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Additionally, you may have these signs and symptoms depending on the type of vaginitis: Bacterial vaginosis. You may develop a grayish-white, foul-smelling discharge. The odor, often described as fish-like, may be more obvious after sexual intercourse. Yeast infections. The main symptom is itching, but you may have a white, thick discharge that resembles cottage cheese. Trichomoniasis. This infection can cause a greenish yellow, sometimes frothy discharge.

Trichomoniasis. metronidazole (Flagyl) or tinidazole (Tindamax) tablets. Atrophic vaginitis. Estrogen, in the form of vaginal creams, tablets or rings, can effectively treat atrophic vaginitis Noninfectious vaginitis. To treat this type of vaginitis, you need to pinpoint the source of the irritation and avoid it. Possible sources include new soap, laundry detergent, sanitary napkins or tampons.

Surgical Nursing

cervicitis

inflammation of the cervix - the lower part of the uterus that extends about one inch into the vaginal canal

In the mildest form of cervicitis, you may not notice any symptoms at all.

Medical Antibiotics are used to treat bacterial infections, such as chlamydia, gonorrhea, and others. Drugs called antivirals may be used to treat herpes infections. Hormonal therapy (with estrogen or progesterone) may be used in women who have reached menopause (postmenopausal).

The first symptom of cervicitis likely will be a vaginal discharge that becomes more pronounced immediately following yourmenstrual period.

Other signs include the following:

Surgical When these treatments have not worked or when cervicitis has been present for a long time, treatment may include:

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Bleeding Itching Irritation of the external genitals Pain during intercourse Bleeding or spotting after sexual intercourse or between periods A burning sensation during urination Lower back pain or pain low in the abdomen, sometimes felt only during sexual intercourse

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Cryosurgery (freezing) Electrocauterization Laser therapy

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y A more severe case of cervicitis can cause a profuse, almost puslike,discharge with
an unpleasant odor, accompanied by intense vaginal itchiness or abdominal pain. If the infection gets into your system, you may also have fever, nausea,

andabdominal pain.

Toxic Shock syndrome (TSS)

a potentially fatal illness caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causativebacteria include Staphylococcus aureus and Streptococcus pyogenes. Streptococcal TSS is sometimes referred to as toxic shock-like syndrome (TSLS) or streptococcal toxic shock syndrome (STSS). Possible Complications

Medical The goal of treatment is to maintain important body functions. This may include:

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Antibiotics for any infection (may be given through an IV) Dialysis (if severe kidney problems are present) Fluids through a vein (IV) Methods to control blood pressure Intravenous gamma globulin may help in severe cases

Severe organ dysfunction

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Shock

Kidney failure Heart failure Liver failure Nursing:

Any foreign materials, such as tampons, vaginal sponges, or nasal packing, will be removed. Sites of infection (such as a surgical wound) will be drained.

Risk factors include:

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Childbirth Staphylococcus aureus (S. aureus) infection, commonly called a Staph infection Foreign bodies or packings (such as those used to stop nosebleeds) Menstruation Surgery Tampon use (particularly if you leave on in for a long time) Use of barrier contraceptives such as a diaphragm or vaginal sponge Wound infection after surgery

Sexually transmitted Disease (STD)

Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. Bacterial

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Unusual vaginal discharge, or any discharge from the rectum or penis. Painful intercourse. Burning or discomfort during urination. Unusual pain or discomfort in the abdomen in women or the testicles in men. Also be aware of any unusual pain in both the buttocks and legs.

Medical: Antibiotics for infections such as Chlamydia, syphilis, gonorrhoea and Trichomonas Penicillin Amoxicillin

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Chancroid (Haemophilus ducreyi) Chlamydia (Chlamydia trachomatis) Granuloma inguinale or (Klebsiella granulomatis) Gonorrhea (Neisseria gonorrhoeae) Syphilis (Treponema pallidum)

Swelling, blisters, open sores, warts, or a rash in the genital area, on the sexual organs, or in the mouth. Flu-like symptoms such as fever, headache, aching muscles, or swollen glands.

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Azithromycin Metronidazole Tinidazole Ceftriaxone Doxycycline Management of HIV Antiretrovirals

Fungal

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Tinea cruris, "jock itch," may be sexually transmitted.
[2]

Management of genital warts Cryotherapy Podophyllin cream Imiquimod cream Freezing


Viral

Candidiasis, yeast infection

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Viral hepatitis (Hepatitis B virus) saliva, venereal fluids. (Note: Hepatitis A and Hepatitis E are transmitted via the fecal-oral route; Hepatitis C (liver cancer) is rarely sexually transmittable,[3] and the route of transmission of Hepatitis D (only if infected with B) is uncertain, but may include sexual transmission.
[4][5][6]

Herpes simplex (Herpes simplex virus 1, 2) skin and mucosal, transmissible with or without visible blisters

Retrovirus like XMRV, HTLV or HIV/ AIDS (Human Immunodeficiency Virus) semen, breast milk, blood venereal fluids,

HPV (Human Papilloma Virus)

skin and

mucosal contact. 'High risk' types of HPV are

known to cause most types of cervical cancer, as well as anal, penile, and vulvar cancer, and genital warts.

Molluscum contagiosum (molluscum contagiosum virus MCV) close contact

Parasites

Crab louse, colloquially known as "crabs" or "pubic lice" (Phthirius pubis)

Scabies (Sarcoptes scabiei)

Protozoal

Trichomoniasis (Trichomonas vaginalis)

Gestational Diabetes Mellitus

a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.[2] No specific cause has been identified, but it is believed that the hormones produced during pregnancy increase a woman's resistance to insulin, resulting in impaired glucose tolerance.

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Blurred vision Fatigue Frequent infections, including those of the bladder, vagina, and skin Increased thirst Increased urination Nausea and vomiting Weight loss in spite of increased appetite

Medical: Nursing:

Avoid high-calorie snacks and desserts, including soda with sugar, fruit punch, candy, chips, cookies, cakes, and full-fat ice cream Using artificial sweeteners, such as aspartame (Nutrasweet), sucralose (Splenda), stevioside (Stevia), or saccharin (Sweet 'N' Low) has not been linked to an increased risk of birth defects. There is no information on the safety of acesulfame potassium (Sunnet) in pregnancy. Eat a lot of vegetables and fruits, at least five servings a day. Some fruits (like grapes, dried fruit) can increase your blood sugar level significantly and should be eaten in limited amounts. Limit starchy vegetables (eg, potatoes), but eat as many nonstarchy fruits or vegetables as you like.

Babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, andjaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. Women with gestational diabetes are at increased risk of developing type 2 diabetes mellitus (or, very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well as having a higher incidence of pre-eclampsia and Caesarean section Molar pregnancy A molar pregnancy happens when tissue that normally becomes afetus instead becomes a growth, called a mole, in your uterus. Even though it is not an embryo, a mole triggers symptoms of pregnancy. A molar pregnancy should be treated right away. This will make sure that all of the mole tissue is removed. This tissue can cause serious problems in some women. About 1 out of 1,000 women with early pregnancy symptoms has a molar pregnancy.1 This means that 999 women out of 1,000 do not have this problem. A molar pregnancy causes the same early symptoms that a normal pregnancy does, such as a missed period or morning sickness. But a molar pregnancy usually causes other symptoms too. These may include:

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Choose foods with whole grains. This includes whole-wheat bread, brown rice, or whole-wheat pasta instead of white bread, white rice, or regular pasta. Eat a limited amount of red meat, and choose lean cuts of meat that end in "loin" (eg, pork loin, tenderloin, sirloin). Remove skin from chicken and turkey before eating. Choose low- or fat-free dairy products, such as skim milk, nonfat yogurt, and low-fat cheese Use liquid oils (olive, canola) instead of solid fats (butter, margarine, shortening) for cooking You will learn how to check

Blood sugar monitoring

your blood sugar level and record the result

Medical Surgical:

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Nursing

vacuum aspiration dilatation and curettage (D&C) hysterectomy,

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There are two types of molar pregnancy: complete and partial.

Bleeding from the vagina. A uterus that is larger than normal. Severe nausea and vomiting. Signs of hyperthyroidism. These include feeling nervous or tired, having a fast or irregular heartbeat, and sweating a lot. An uncomfortable feeling in the pelvis. Vaginal discharge of tissue that is shaped like grapes. This is usually a sign of molar pregnancy.

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Complete molar pregnancy. An egg with no genetic information is fertilized by a sperm. The sperm grows on its own, but it can only become a lump of tissue. It cannot become a fetus. As this tissue grows, it looks a bit like a cluster of grapes. This cluster of tissue is called a mole, and it can fill the uterus. Partial molar pregnancy. An egg is fertilized by two

Measuring hCG levels every 1 to 2 weeks until they are normal, then measuring them every 1 to 2 months for 6 months to a year. Levels of hCG that stay high may be a sign of cancer. Preventing pregnancy while hCG levels are being monitored, usually about 6 months. It is very important that you practice highly effective birth control during the entire period of follow-up. For more information on contraception, see the topic Birth Control. Close medical supervision if you happen to conceive within 12 months of molar pregnancy treatment.

sperm. Normally this creates twins. But in a partial molar pregnancy, something goes wrong. The placenta grows into a mole instead. Any fetal tissue that forms is likely to have severe defects.

Abortion Types of Abortion: 1. Spontaneous abortion or miscarriages - is a type of abortion that occur without medical or other intervention. y Threatened abortion y Inevitable abortion y Complete abortion .

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Incomplete abortion Missed abortion

2. Induced abortion - this type of abortion uses drugs or instruments to stop the normal course of pregnancy

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Menstrual Extraction (endometrial or vacuum aspiration). Dilation and Evacuation (D & E)