Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran.
Eur J Obstet Gynecol Reprod Biol. 2011 Apr;155(2):217-20. doi: 10.1016/j.ejogrb.2010.12.010. Epub 2011 Jan 13.
We performed this study in order to investigate the role of chronic endometritis (CE) in unexplained recurrent spontaneous abortion (RSA) and to determine the correlation between hysteroscopic and histologic findings of CE in patients with unexplained RSA. We also tried to find out the relation between CE and primary vs. secondary RSA.
One hundred and forty-two consecutive patients with unexplained RSA and 154 fertile women were enrolled in this study. All the patients and controls underwent hysteroscopy and, at the same time, endometrial biopsy. CE was suspected when hysteroscopy revealed signs of focal or diffuse endometrial hyperemia or endometrial endopolyps (less than 1mm in size). Histopathologic diagnosis of CE was based on superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes and plasma cells. Results were compared between cases and controls as well as those with primary (n=61) and secondary (n=81) RSA.
Patients with RSA had a significantly higher incidence of CE both hysteroscopically (67.6% vs. 27.3%; p<0.0001) and pathologically (42.9% vs. 18.2%; p<0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy in the diagnosis of CE were found to be 98.4%, 56.23%, 63.5% and 97.82% respectively. Patients with secondary RSA had a higher prevalence of CE both pathologically (83.9% vs. 45.9%; p<0.0001) and hysteroscopically (58.1% vs. 24.6%; p<0.0001).
CE is associated with unexplained RSA. Hysteroscopy, with high sensitivity and acceptable specificity, is suitable for the diagnosis of CE in those with unexplained RSA. CE should be taken into consideration in those with secondary unexplained RSA.
本研究旨在探讨慢性子宫内膜炎(CE)在不明原因复发性自然流产(RSA)中的作用,并确定不明原因 RSA 患者宫腔镜下和组织学 CE 表现之间的相关性。我们还试图探讨 CE 与原发性和继发性 RSA 之间的关系。
本研究纳入了 142 例连续不明原因 RSA 患者和 154 例生育期妇女。所有患者和对照组均接受了宫腔镜检查,并同时进行了子宫内膜活检。当宫腔镜检查显示局灶性或弥漫性子宫内膜充血或子宫内膜息肉(大小小于 1mm)时,怀疑存在 CE。CE 的组织病理学诊断基于浅层基质水肿、基质密度增加以及以淋巴细胞和浆细胞为主的多形性基质炎症浸润。将结果与病例和对照组以及原发性(n=61)和继发性(n=81) RSA 患者进行比较。
RSA 患者的 CE 发生率在宫腔镜下(67.6% vs. 27.3%;p<0.0001)和组织病理学上(42.9% vs. 18.2%;p<0.0001)均显著更高。宫腔镜诊断 CE 的灵敏度、特异度、阳性预测值和阴性预测值分别为 98.4%、56.23%、63.5%和 97.82%。继发性 RSA 患者的 CE 发生率在组织病理学上(83.9% vs. 45.9%;p<0.0001)和宫腔镜下(58.1% vs. 24.6%;p<0.0001)均更高。
CE 与不明原因 RSA 相关。宫腔镜检查具有较高的灵敏度和可接受的特异度,适用于诊断不明原因 RSA 患者的 CE。对于继发性不明原因 RSA 患者,应考虑 CE 的存在。