Diagnostic significance of chronic endometritis macrotypes differentiation among women with reproductive losses

Abstract

To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation–hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87)–was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.