Chronic Endometritis Due to Common Bacteria Is Prevalent in Women With Recurrent Miscarriage as Confirmed by Improved Pregnancy Outcome After Antibiotic Treatment

Abstract

Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks' pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hysteroscopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P = .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome.

Altered uterine contractility in women with chronic endometritis

“…In accordance with its detrimental role, CE has been detected in 14% of women with unexplained infertility, and in 23.6% of women with a history of first-trimester miscarriages (20,21). In a recent report, we demonstrated that in women who have had repeated spontaneous abortions CE is a common finding, and that women who received adequate antibiotic treatment had a significantly higher rate of successful pregnancies (22). Moreover, CE was identified in 30.3% of patients with repeated implantation failures at IVF, and women with a CE diagnosis had lower implantation rates (11.5%) after IVF cycles (17).…”

Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss

“…The reported prevalence of CE among women with RPL is highly variable in the scientific literature (4)(5)(6)(7). This variability is likely secondary to various techniques used for the diagnosis of CE.…”

Chronic endometritis and habitual miscarriage

“…Этиологию процесса подтверждают и многочислен-ные исследования Cicinelli et al, проанализировавших истории болезни 360 женщин ретроспективно [10]. Процессы воспаления постоянно происходят в нормаль-ном эндометрии.…”

“…По данным Cicinelli et al [10], при гистологическом исследовании следует обратить внимание на отек стро-мы, увеличение ее плотности, наличие плеоморфного стромального инфильтрата с преобладанием лимфоци-тов и плазматических клеток. Столь бурная реакция иммунной системы возникает в ответ на действие чуже-родного микробного агента.…”