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The rate of genital Mycoplasma isolation from the uterine cavity was studied in 147 puerperae (80 ones with a normal course of the puerperium and 67 with acute postpartum endometritis). Mycoplasma were isolated from the metroaspirate in 11.3% of puerperae in whom the postpartum period ran a normal course; M. urealyticum were found in 8.8% and M. hominis in 2.5% of cases. In endometritis Mycoplasma were isolated from the infection focus 2.5 times more often, i.e. from 28.4% of patients with postpartum endometritis (M. urealyticum were detected in 9.0% and M. hominis in 19.4% of cases). Mycoplasma were the sole agents of endometritis in 9.0% of patients. Hysteroscopic and morphologic studies helped verify the contribution of genital Mycoplasma to the development of acute postpartum endometritis in 19.4% of the patients. Therefore, virtually every fifth patient with postpartum endometritis was in need of purposeful antimycoplasma therapy with tetracycline.

The authors report a study on clinical and microbiological aspects of endometritis in 50 parturients. The analysis of results shows that major risk factors for the development of puerperal endometritis are urgent Caesarean section, premature rupture of membranes for more than 15 hours and surgical vaginal delivery. In conclusion the authors propose their actual clinical view on diagnosis and treatment of puerperal endometritis.

Thymogen, a new immunomodulating drug made in this country, was used in combined therapy of 46 patients with acute endomyometritis, exacerbations of chronic salpingo-oophoritis, purulent tubo-ovarian formations. Thymogen therapy was conducive to normalization of lymphocyte counts, absolute counts of T and B lymphocytes, increase of T lymphocyte functional activity. The drug is characterized by a desensitizing effect and induces no complications. Marked clinical effect recommends the immunomodulator thymogen for combined therapy of patients with inflammatory diseases of the uterus and its appendages.

The endometrium of 72 puerperae referred to a high-risk group in respect of developing infectious complications was examined on days 3-18 of the puerperium. The periods of epithelialization and regeneration onset in abnormal course of the puerperium were detected, and the morphologic criteria of these processes specified. In cases with cesarean sections these processes started 2-3 days later than after spontaneous delivery. Bacteriologic examination of the uterine cavity contents is an indirect test for the detection of an infection; the final diagnosis may be made only after a comprehensive assessment of the endometrial status.

Echography supplemented by hysteroscopy helped detect signs of partial separation of the sutures on the uterus in 12 of 33 patients with grave endometritis following cesarean section. Therapeutic policy in such cases should be based on rational etiotropic antibiotic therapy and active local treatment of the involved focus (surgical treatment of the uterine cavity walls, drainage of the uterus, local multicomponent ointments with a hydrophilic base). The treatment helped preserve the uterus and resulted in complete cure in 11 of the 12 cases.

Analysis of phagocytosis parameters in uterine lochia and measurements of polyvalent proteinase inhibitor and alkaline phosphatase activities, as well as of lipid peroxidation parameters in uterine lochia are recommended for the early diagnosis of endometritis following a cesarean section. Local changes in the defense and injurious factors forerun the development of an inflammation in the uterine cavity whereas systemic changes develop after the manifestation of clinical symptoms of endometritis. The findings indicate that development of endometritis following an abdominal delivery may be prevented by routine therapy supplemented by thymalin and intrauterine metronidazole. Therapy of endometritis developing after cesarean section should include immunomodulators, chosen individually, and administered in combination with intrauterine contrycal.

A retrospective analysis of 1000 case histories of women who delivered by cesarean section has helped define the principal factors of postsurgical endometritis risk. If the risk factors are combined, the potentiality of the disease development increases. The most hazardous combinations of risk factors are as follows: grave gestosis combined with obesity, anemia, and a chronic infection focus, as well as clinical non-correspondence of the maternal pelvis to fetal head, combined with dry labor.

Clinical presentations of acute inflammatory adnexae diseases (AIAD) have been delineated in 127 patients who were users of intrauterine contraceptives (IUC). It was found that these diseases occurred with severe clinical symptoms in IUC users and were associated with prominent morphologic lesions: pyosalpinx and suppurative ovarian inflammation in every 2nd case, suppurative endomyometritis in every 3rd and parametritis in every 10th case. To prevent AIAD, the use of IUC should rigorously follow indications and contraindications. The use of IUC ought not be protracted beyond 3 years.

The immune status has been assessed in 73 patients with postabortal endometritis and thymalin and T-activin have been evaluated as an intervention for secondary immunodeficiency associated with this condition. These drugs were found to have immunomodulating effects on quantitative and qualitative characteristics of T- and B-lymphocytes and their subpopulations and on phagocytic function of polynuclears. Comprehensive therapy using thymalin and T-activin improves the efficacy of management of postabortal endometritis.

The authors studied ultrastructural changes in the endometrium of 25 women, using intrauterine contraceptive devices, preventing conception, during various time limits. The material of the endometrial biopsy was fixed with glutar and osmium in a phosphate buffer and embedded in durcopan. Section were prepared by a microtome and observed under electron microscope of Hitachi type. Comparing the parameters duration of usage of loops and character of changes in the endometrium an impression was obtained that the usage of contraceptive intrauterine devices for one-year period did not induced changes of pathological character. Functional changes in the endometrium occurred after a two-year stay of the loop in the uterus as there were inflammatory changes of spot-like character in two of the sections. Local areas of inflammation of nonspecific character, manifested under the form of lymphocytes and leucocyte accumulation, were found in women with long usage of contraceptive intrauterine devices. The authors advise to remove the loop 2.5-3 years after its application and to wait for the complete regeneration of the endometrium.