Relation between chronic endometritis and recurrent miscarriage

Area of Science:

• Reproductive Medicine
• Gynecologic Pathology
• Diagnostic Accuracy Studies

Background:

• Chronic endometritis (CE), an endometrial inflammation, is increasingly associated with recurrent miscarriage (RM).
• Understanding the relationship between CE and RM is crucial for improving reproductive outcomes.
• Asymptomatic inflammation of the endometrium warrants investigation in women experiencing recurrent pregnancy loss.

Purpose of the Study:

• To evaluate the association between chronic endometritis (CE) and recurrent miscarriage (RM).
• To determine the diagnostic accuracy of hysteroscopy in identifying CE in women with RM.
• To identify common pathogens contributing to CE in this patient population.

Main Methods:

• 110 women with unexplained recurrent miscarriage (RM) underwent diagnostic hysteroscopy.
• Hysteroscopic diagnosis of CE was based on specific visual signs (micro-polyps, edema, hyperemia).
• Endometrial biopsy for culture and immunohistochemical (IHC) staining was performed post-hysteroscopy.

Main Results:

• The prevalence of CE was 31.8% by hysteroscopy and 38.2% by biopsy (IHC/culture), with no significant difference (p=0.4).
• Hysteroscopy demonstrated 64.1% sensitivity and 85.9% specificity for CE diagnosis.
• Hysteroscopy achieved 78.2% overall accuracy, with 71.4% PPV and 81.3% NPV.

Conclusions:

• Hysteroscopy is a valuable tool for diagnosing chronic endometritis (CE) in women with recurrent miscarriage (RM), exhibiting good specificity and overall accuracy.
• The study confirms a significant prevalence of CE in women experiencing RM.
• Mycoplasma and other common pathogens were identified as the primary causative agents in over 81% of CE cases.