Diagnosis of chronic endometritis in women with habitual miscarriage

Abstract

Habitual miscarriage is an acute medical and socio-economic problem today. Unfortunately, no matter how high-tech progress in medicine has been in recent years, a clear determination of the etiology has not yet been determined. However, a number of diseases have been identified that have a close cause-and-effect relationship with repeated miscarriages. It has been clearly established that genetic defects, anatomical anomalies of the reproductive system, immunological disorders, endocrinological diseases, inflammatory diseases of the pelvic organs, and even unexplained etiology can lead to reproductive losses. Chronic endometritis (СЕ) is one of the diseases that occupies a leading position in the distribution of etiological factors of habitual termination of pregnancy. The complexity of treating habitual miscarriage on the background of СE is associated with the lack of a standardized approach to the diagnosis of these disorders. Chronic endometritis has been the subject of scientific research for many years, but the issue of optimizing treatment and diagnostic approaches and eliminating reproductive disorders associated with chronic endometritis remains extremely relevant. Ultrasound diagnostics is a sensitive, but not specific, method of diagnosing СE, as it does not register pathognomonic ultrasonographic symptoms. Nevertheless, heterogeneity of the structure of the endometrium, violation of the thickness of the endometrium, inconsistency of its parameters with the phase of the cycle are the most common signs of СE during ultrasonography. Endometrial biopsy followed by pathomorphological analysis is the main method for confirming the inflammatory process of the endometrium. For the purpose of taking the material, two methods were used: pipel biopsy and biopsy with the help of hysteroscopy. Examination of biopsies aimed at the detection of plasma cells has been the main method of diagnosis of CE for many decades. However, a number of errors forced the search for more reliable markers for the verification of this pathology. Standard histological detection of plasma cells in endometrial samples confirmed СЕ in only 68.06% of the examined women, while immunohistochemical registration of CD-138 expression in these same examined women gave a 100% indicator. That is why endometrial biopsy followed by immunohistochemical analysis for the expression of CD-138 is the "gold standard" in the diagnosis of CE.