Anatomo-functional characteristics of the pelvic organs in women with habitual miscarriage and chronic endometritis
Chronic endometritis is a clinical and morphological syndrome, which under the influence of an infectious agent contributes to the violation of cyclic biotransformation and reciprocity of the endometrium. In the diagnosis of gynecological pathology, in particular chronic endometritis, or habitual miscarriage on the background of chronic endometritis, ultrasonography is a mandatory, non-invasive and highly specific method of research. The aim of the study was to assess the anatomical and functional condition of the pelvic organs in women with habitual miscarriage and chronic endometritis using ultrasound (ultrasound and Doppler) criteria. We examined 98 women of childbearing age who applied to the Inomed clinic in the city of Vinnytsia during 2019-2020. Patients were divided into two groups: the main group – 68 women with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women without previous pregnancy loss. Initially, ultrasound examination (ultrasound) of the pelvic organs was performed on day 5-7 of the menstrual cycle, and to monitor folliculogenesis, the study was repeated on day 13-17 of the cycle. One of the main signs of chronic endometritis is the heterogeneity of the structure of the endometrium, which was found in the vast majority of examined patients of the main group (80.88% at n=68). When determining the thickness of the endometrium, two diametrically opposite processes were established, namely: atrophy (39.71% at n=68) and atypical glandular hyperplasia (22.05% at n=68). In the second half of the menstrual cycle there was a significant thinning of the endometrial layer <0.6 cm. In the control group during the ultrasound examination revealed the following disorders: increased uterine peristalsis, dilation of the arcuate plexus, the heterogeneity of the subendometrial layer, and when re-ultrasound took into account the data of folliculogenesis. Follicular cysts were detected in 10.3% of cases in the main group and 3.3% in the control group of women. At the time of re-ultrasound in each ovary was observed 5-8 antral follicles (the size of which ranged from 6.8 mm to 11.5 mm) with the presence of one dominant, the size of which ranged from 18.2 to 23.4 mm. In order to increase the informativeness of ultrasound, Doppler was additionally performed. Thus, ultrasonography is a highly specific method for determining the anatomical and functional characteristics of the pelvic organs, in particular the pathology of the endometrium in women with habitual miscarriage. The main ultrasound characteristics of chronic endometritis, as one of the causes of reproductive losses, are changes in endometrium structure, thickness, the presence of additional structures (polyps) and fluid component. Informativeness of ultrasound examination of structural changes in the endometrium in chronic endometritis is complemented by Doppler characteristics of blood flow in the basal and spiral arteries of the uterus.
 Bochkov, V. V., Plekhanov, A. N., & Tsydenova, Ts. B. (2015). Chronic nonspecific endometritis: epidemiology, etiology, pathogenesis, risk factors, diagnosis. Bulletin of the Buryat State University. Medicine and Pharmacy, 12, 30-38.
 Cicinelli, E., Matteo, M., Tinelli, R., Lepera, A., Alfonso, R., Indraccolo, U. … Resta, L. (2015). Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction, 30(2), 323-330. https://doi.org/10.1093/humrep/deu292
 Cicinelli, E., Resta, L., Nicoletti, R., Tartagni, M., Marinaccio, M., Bulletti, C., & Colafiglio, G. (2005). Detection of chronic endometritis at fluid hysteroscopy. Journal of Minimally Invasive Gynecology, 12(6), 514-518. https://doi.org/10.1016/j.jmig.2005.07.394
 Cicinelli, E., Resta, L., Nicoletti, R., Zappimbulso, V., Tartagni, M., & Saliani, N. (2005). Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Human Reproduction (Oxford, England), 20(5), 1386-1389. https://doi.org/10.1093/humrep/deh779
 Groth, J. V. (2018). Chronic endometritis and the plasma cell, fact versus fiction. Fertility and Sterility, 109(5), 788. https://doi.org/10.1016/j.fertnstert.2018.02.116
 Kishakevich, I. T., Kotsabin, N. V., & Radchenko, V. V. (2017). Endometrium in the focus of gynecologist: the role of hysteroscopy and immunohistochemistry in the diagnosis of chronic endometritis, the choice of treatment. Reproductive Endocrinology, 34(2), 24-27. ISSN: 2309-4117.
 Kitaya, K., Matsubayashi, H., Yamaguchi, K., Nishiyama, R., Takaya, Y., Ishikawa, T. … Yamada, H. (2016). Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. American Journal of Reproductive Immunology, 75(1), 13-22. https://doi.org/10.1111/aji.12438
 Kitaya, K., Takeuchi, T., Mizuta, S., Matsubayashi, H., & Ishikawa, T. (2018). Endometritis: new time, new concepts. Fertility and Sterility, 110(3), 344-350. https://doi.org/10.1016/j.fertnstert.2018.04.012
 Kondratyuk, V. V. (2015). Instrumental research methods in gynecology. Medical Aspects of a Woman’s Health, 90(4), 10-19.
 Kornienko, S. M. (2017). Ultrasonographic criteria in the differential diagnosis of endometrial polyps and chronic endometritis. Bulletin of Vinnytsia National Medical University, 21(1/1), 49-54.
 Kozyreva, E. V., Tyurina, N. A., Andreeva, N. A., Merenkova, I. V., & Kuznetsova, M. A. (2019). Ultrasonic and dopplerometric characteristics of chronic endometritis of women with infertility and miscarriage. Electronic Journal of General Medicine, 16(2), em108. https://doi.org/10.29333/ejgm/106075
 Kuznetsova, A. V. (2000). Chronic endometritis. Archive of Pathology, 3, 48-52.
 Lisitsa, V. (2018). Management of patients with inflammatory diseases of the pelvic organs. Review of the recommendations of the British Association for Sexual Health and HIV. Medical Aspects of Women’s Health, 3, 17-23.
 Liu, Y., Chen, X., Huang, J., Wang, C. C., Yu, M. Y., Laird, S., & Li, T. C. (2018). Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertility and Sterility, 109(5), 832-839. https://doi.org/10.1016/j.fertnstert.2018.01.022
 Moreno, I., Cicinelli, E., Garcia-Grau, I., Gonzalez-Monfort, M., Bau, D., Vilella, F. … Simon, C. (2018). The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. American Journal of Obstetrics and Gynecology, 218(6), 602. https://doi.org/10.1016/j.ajog.2018.02.012
 Moreno, I., Codoñer, F. M., Vilella, F., Valbuena, D., Martinez-Blanch, J. F., Jimenez-Almazán, J. … Simon, C. (2016). Evidence that the endometrial microbiota has an effect on implantation success or failure. American Journal of Obstetrics and Gynecology, 215(6), 684-703. https://doi.org/10.1016/j.ajog.2016.09.075
 Ni, J., Han, B., Liang, J., & Wang, F. (2019). Three-dimensional 3D ultrasound combined with power Doppler for the differential diagnosis of endometrial lesions among infertile women. International Journal of Gynaecology and Obstetrics, 145(2), 212-218. https://doi.org/10.1002/ijgo.12787
 Radko, V. Yu. (2016). Prevention of miscarriage in women with a history of chronic endometritis. Diss. abstract for the degree of Cand. of Med. Scien.: 14.01.01. Kyiv: National Medical Academy of Postgraduate Education P.L. Shupik.
 Sfakianoudis, K., Simopoulou, M., Nikas, Y., Rapani, A., Nitsos, N., Pierouli, K. … Pantos, K. (2018). Efficient treatment of chronic endometritis through a novel approach of intrauterine antibiotic infusion: a case series. BMC Women’s Health, 18(1), 197. https://doi.org/10.1186/s12905-018-0688-8
 Snopkova, L. V., Cherepova, V. I., Kandyba, L. I., & Sikal, I. M. (2019). Modern possibilities of diagnosis of chronic endometritis. Problems of Continuing Medical Education and Science, 35(3), 68-72. https://doi.org/10.31071/promedosvity2019.03.068
 Sun, J. (2010). Vitamin D and mucosal immune function. Current Opinion in Gastroenterology, 26(6), 591-595. doi: 10.1097/MOG.0b013e32833d4b9f
 Troedsson, M. H., & Woodward, E. M. (2016). Our current understanding of the pathophysiology of equine endometritis with an emphasis on breeding-induced endometritis. Reproductive Biology, 16(1), 8-12. https://doi.org/10.1016/j.repbio.2016.01.003
 Veropotvelyan, P. N., Tsekhmistrenko, I. S., Veropotvelyan, N. P., & Guzhevskaya I. V. (2016). A practitioner’s perspective on pelvic inflammatory disease in women. Medical Aspects of Women’s Health, 101(4), 46-53. ISSN: 2311-5335
 Viana, G. A., Cela, V., Ruggiero, M., Pluchino, N., Genazzani, A. R., & Tantini, C. (2015). Endometritis in Infertile Couples: The Role of Hysteroscopy and Bacterial Endotoxin. JBRA assisted reproduction, 19(1), 21-23. https://doi.org/10.5935/1518-0557.20150006
 Vovk, I. B., Timchenko, O. I., Revenko, O. O., & Revenko, O. M. (2014). Abortion is a predictor of a woman’s reproductive health. Health of Ukraine, 44-47. Taken from: http://health-ua.com/pics/pdf/ZU_2014_Akusher_1/44-47.pdf
 Yang, R., Du, X., Wang, Y., Song, X., Yang, Y., & Qiao, J. (2014). The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Archives of Gynecology and Obstetrics, 289(6), 1363-1369. https://doi.org/10.1007/s00404-013-3131-2
 Zhabchenko, I. A. (2018). Habitual miscarriage: what to do and what not to do (Review). Woman’s Health, 127(1), 9-13. doi: 10.15574/hw.2018.127.9
 Zolghadri, J., Momtahan, M., Aminian, K., Ghaffarpasand, F., & Tavana, Z. (2011). The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 155(2), 217-220. https://doi.org/10.1016/j.ejogrb.2010.12.010
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