Causes of Pyometra
It is primarily caused by impairment of natural drainge of the cervix due to malignant diseases of genital tract and consequences of their treatment with radiotherapy. Other causes include:Senile cervicitisEndometrial polypsPuerperal infectionsGenital tuberculosisCervical occlusion after surgeryLeiomyomaCongenital cervix anomaliesForgotten intra-uterine device
Sign and Symptoms of PyometraPyometra often doesn’t cause any symptoms and can be found during an ultrasonography of pelvis. Signs and symptoms that may be experienced by affected women include:Purulent vaginal discharge with traces of bloodPostmenopausal bleedingLower abdominal painSymmetrical enlargement of the uterusNausea and vomitingDiarrheaPyrexia (rarely)
To rule out other causes of uterine enlargement following must be taken in consideration: 1) uterine causes – fibroids and adenomyosis, 2) endometrial causes – polyps, haematometra, endometrial tumor and gestational trophoblastic neoplasia, 3) congenital abnormalities.
Causes of blood-stained vaginal discharge that need to be excluded are: vaginosis, vulvar vestibulitis and different infections of genital tract.
The diagnosis of pyometra is usually difficult because it is often asymptomatic. If tubercular pyometra is suspected, diagnosis can be confirmed by tuberculin testing, histology, hysterosalpingogram or PCR. Ultrasound scanning is used in most cases but sometimes can be used CT and magnetic resonance. Doppler scanning is used when pyometra possibly occurred due to endometrial cancer. X- ray is used to detect spontaneous perforation of the uterus.
Pyometra sometimes requires hysterectomy. Many women are treated with cervical dilation and drainage of collected pus. Pyometra can recur hence regular monitoring is necessary. Antibiotics are given if there is an invasive infection characterized by generalized malaise, pyrexia or altered laboratory parameters. Anti-tubecular chemotherapy is a treatment for tubercular pyometra.
Pyrometra cannot be prevented but women who had undergone radiotherapy, have gynecological malignancy or had egg retrieval must be regularly monitored with an ultrasound scanning or other diagnostic tools.
Prognosis of pyometra depends on concurrent medical condition as well as if spontaneous perforation of the uterus has occurred. Cases of spontaneously perforated pyometra has better prognosis if it not associated with malignancy. Pyometra that is promptly diagnosed and treated will have better prognosis.