What is a parametrium and how does it become inflamed?
Parametrium is the loose fatty and connective tissue that surrounds the cervix and body of the uterus and extends to the side walls of the pelvis. The uterine vessels and ureter pass through it. The infection enters here most often from the uterine cavity - through the lymphatic tract or through the veins, less often with direct damage to the wall during the intervention. The tissue is saturated with inflammatory effusion, a dense infiltrate is formed, which spreads to the sides and down. If the course is favorable, it gradually resolves; if the course is unfavorable, it suppurates.
- Lateral parametritis is the most common option
- Anterior parametritis extending to the bladder
- Posterior parametritis with transition to the rectum
- Infiltration stage
- Stage of suppuration with abscess formation
- Stage of scarring with tissue deformation
Causes and risk factors
The main reasons are related to interventions and childbirth. Cervical ruptures during childbirth, manual separation of the placenta, cesarean section, abortion, curettage, installation of an intrauterine device - all this creates an entry point for infection. The second large group of causes is untreated or undertreated endometritis and inflammation of the appendages. Less commonly, inflammation spreads from neighboring organs: with appendicitis, inflammation of the peri-rectal tissue, urinary tract infections. Reduced immunity, anemia, diabetes mellitus and chronic foci of infection in the body contribute to the development.
- Complicated childbirth, cervical ruptures
- Caesarean section and manual labor interventions
- Abortion and curettage of the uterine cavity
- Insertion of an intrauterine device
- Untreated endometritis
- Operations on the uterus and appendages
- Sexually transmitted infections
- Anemia, diabetes, reduced immunity
Symptoms
The disease begins a few days after childbirth, abortion or intervention. The first to appear is a persistent increase in temperature, which is poorly reduced by antipyretics, with chills and sweating. The pain in the lower abdomen is constant, dull, radiates to the sacrum, lower back and thigh, intensifies with movement. If the infiltrate puts pressure on the bladder or rectum, frequent painful urination, false urges, and constipation occur. When suppuration occurs, the temperature becomes fluctuating and the condition worsens. Sometimes swelling of the leg develops due to compression of the blood vessels.
- Persistent high fever with chills
- Constant pain in the lower abdomen
- Referral of pain to the sacrum, lower back, hip
- Frequent, painful urination
- False urge to defecate, constipation
- Purulent or bloody discharge
- Weakness, sweating, rapid pulse
- Swelling of the leg on the side of inflammation
Diagnostics
The key information is provided by a two-manual vaginal examination: the doctor determines a dense, painful infiltrate on the side of the uterus, reaching the pelvic wall, while the uterus is displaced to the opposite side and is poorly mobile. The tests revealed pronounced leukocytosis, accelerated ESR, high C-reactive protein, and often anemia. A pelvic ultrasound shows tissue changes, fluid accumulation and helps distinguish infiltration from an abscess. When in doubt and when planning an intervention, MRI or CT is more informative. Cervical canal and blood cultures and urine analysis are required.
- Two-manual vaginal and rectal examination
- Complete blood count and C-reactive protein
- Ultrasound of the uterus and appendages
- MRI or CT scan of the pelvis for suspected abscess
- Smear and culture from the cervical canal
- Examination for chlamydia, mycoplasma, ureaplasma
- Blood culture for high fever
- General urine test and kidney ultrasound
Treatment and recovery
Treatment begins in the hospital with broad-spectrum intravenous antibiotics, which are then adjusted based on culture results. Additionally, infusion therapy, pain relief, anemia are treated, and rest and cold are provided to the lower abdomen in the acute phase. If an abscess has formed, it must be opened and drained - often through the posterior vaginal fornix, sometimes through the anterior abdominal wall. After the acute phenomena subside, physiotherapy and resorption treatment are added, which reduce the risk of dense scars. Recovery takes several weeks.
- Hospitalization and intravenous antibiotic therapy
- Correction of treatment based on culture results
- Infusion therapy and pain management
- Treatment of anemia
- Opening and draining the abscess
- Removal of the intrauterine device due to its role in the development of inflammation
- Physiotherapy and resorption therapy after the acute phase
- Observation by a gynecologist and ultrasound control
- Examination and treatment of sexual partner for infection
