Chronic Endometritis as a Cause of Miscarriage

Abstract

Objective: to evaluate the immunohistochemical and microbiological features of the endometrium in female patients with miscarriage. Material and methods. 60 female patients of reproductive age have been examined. The study group comprised 40 (66.67%) patients with miscarriage, the comparison group included 20 (33.33%) patients without reproductive pathology who had been examined before pregnancy. All the patients underwent the immunohistochemical examination of the endometrium and cultural study of the material obtained from the uterine cavity. Endometrial biopsy in the patients was performed depending on the duration of the menstrual cycle on 7-9 days after ovulation using the aspiration curette ProfiCombi («Simurg», Belarus). Results. During the immunohistochemical examination of the endometrium 29 (72.50 %) patients with miscarriage were diagnosed with chronic endometritis, the comparison group did not reveal the pathology (c² = 28.06, p < 0.001). Microorganisms in the uterine cavity were detected in 22 (55.00 %) patients with miscarriage and in 1 (5.00 %) patient of the comparison group (c² = 14.10; p = 0.0002), 15 (37.50 %) patients of the study group observed massive growth of microorganisms (c² = 10.00; p = 0.002). The predominant type of microorganisms in the uterine cavity was Escherichia coli , isolated in 11 (27.50 %) patients with miscarriage (c² = 6.00; p = 0.03). Conclusion. Miscarriage is associated with chronic endometritis in 72.50 % of the patients (p < 0.001). The combination of chronic endometritis and miscarriage leads to the infiltration by CD56-lymphocytes (p < 0.001), which causes the development of local immune reactions of the recognition of the fertilized ovum and reproductive losses. Persistent infection in the endometrium in 55.00 % patients of the study group (p = 0.0002) can cause serious complications not only for the uterus, but also can affect the health of the fetus and newborn, which demands the microbiological examination of the endometrium aimed at the solution of the problem of miscarriage.