Relationship of chronic endometritis with chronic deciduitis in cases of miscarriage.

Abstract

Background: The presence of chronic deciduitis (CD) was determined in patients diagnosed with or without chronic endometritis (CE) before pregnancy to study the effect of CE on decidua in cases of miscarriage.Methods: Decidual tissue was obtained from the patients who miscarried at the first pregnancy within a year after the diagnosis of the presence or absence of CE. The number and distribution pattern of plasma cells stained with CD138 in decidual tissue in 10 high-power fields (HPFs) was examined. The prevalence of CD diagnosed with four different grade; grade 0, no plasma cell in 10 HPFs, thus Non-CD ;grade 1, rare single plasma cells; grade 2, rare clusters or more than 5 single cells total; and grade 3, many plasma cells with more than 5 clusters, were examined and compared between Non-CE and CE.Results: The incidence rate of CD of grade2+3 was significantly higher in CE than Non-CE (53.8%; 7/13 vs. 0%; 0/13, P<0.01). Presence of clusters or a number of plasma cells in 10 HPFs of decidua showed a sensitivity of 53.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.4% for the diagnosis of CE.Conclusion: Presence of clusters of plasma cells or five or more of plasma cells in decidua was found in more than half of CE, but not found in Non-CE. When CD with cluster or five or more of plasma cells is confirmed histologically in miscarriage decidual tissue, the presence of CE before the pregnancy should be suspected.

The effects of chronic endometritis on the pregnancy outcomes

“…We have recently reported that chronic deciduitis (CD) was found more frequently in miscarriage cases among CE patients than Non-CE patients. 34 CD is thought to be a type of continuous and subtle inflammation in the decidua during pregnancy. [35][36][37][38][39] Chronic infection of microorganisms with immune disorder has been implicated as the pathophysiology of CD.…”

“…these specimens were already included and analyzed in the previous study. 34 The microbiome itself and/or inflammatory cytokines induced by this bacterium may affect embryonic development and cause miscarriage. 35,36 However, CE reportedly modifies decidualization.…”

Alteration in endometrial helper T‐cell subgroups in chronic endometritis

“…1,2 However, it has recently been noted that CE is associated with unexplained infertility, impaired implantation, and miscarriage. [3][4][5][6][7] The microbiota are deeply involved in the etiology of CE, since the cure rate is high with antibiotics treatment, and the clinical outcomes of in vitro fertilization (IVF) are improved after the confirmation of its cure. 3 The response of the endometrium to the microbiota and/or the microbiota itself is thus considered to be closely associated with implantation failure and infertility.…”