Sabato 27 ottobre 2012 - Pacini Editore

382
GEnITALE MASCHILE E FEMMInILE
Post-partum metrorrhagia and endometritis:
a retrospective study
S. Bruno, A. Guadagno, E. Pacella, L. Abete, P. Rossella, O. Dimitri,
E. Fulcheri
University of Genoa, Histopathology, DISC, Azienda Ospedaliera e Universitaria
“San Martino” IRCCS, Genova
Introduction. Metrorrhagia and endometritis are complications
than can occur in the post-partum. A placental cause often underlies
these clinical conditions; examples include disorders of
implantation or placenta accreta 1 . Occasionally however we may
find metrorrhagia of varing duration, caused be retention of chorionic
disc parts, but without signs of accretion. The most frequent
cause of endometritis is secondary to an ascending infection from
the birth canal. In fact, the uterine mucosae, after birth, becomes
extremely sensitive to the effect of different pathogenetic organisms,
mainly due to the extensive necrotic-haemorrhagic phenomena
related to the placentas detachment and expulsion.
Methods and Materials. In our study we evaluated 92 cases of
uterine cavity revisions performed in the Department of Obstet-
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
rics and Gynaecology of the University-IRCCS-IST San Martino
Hospital, between January 1999 to December 2011 out of a total
of 25,470 births.
For each cases we re-evaluated the histological reports.
Of these 92 cases:
30 had a “post-partum endometritis” diagnosis
62 had a “retention of part of the chorionic disc or placenta accreta”
diagnosis,
Out of the 92 cases, a further selection was made to include
only those cases which also had histologic examination of the
placenta, in order to determine the possible correlation with and
the main cause of endometritis. We therefore selected 24 patients
(age range 20-46 years).
Results: Out of the 24 cases with placenta at histology. Ten
patients (10/24 - 42%) had a diagnosis of endometritis and histologic
sampling of the placenta which showed the abnormalities
as reported in Figure 1. Fourteen cases (14/24 - 58%) had
a diagnosis of retention of chorionic parts or placenta accreta.
Out of these, 4 had placenta accreta associated with hypoxia/
ischemic injury (HII) in 2 cases, an immature placenta in 1
case and evidence of chronic villitis in the remaining case. Ten
patients had retention of chorionic parts associated with a wide
variety of conditions as shown in Figure 1. In 5 of the 24 cases
Fig. 1. Schematic rappresentation of the 92 cases selected cases. 24 also had a histologic evaluation of the placenta. dp: diabetic placentopathy. Hii:
hypoxic/ischemic injury. C: chorionamnionitis.