Hysteroscopic and Pathologic Evaluation of Chronic Endometritis in Patients with Unexplained Recurrent Spontaneous Abortion

Chronic endometritis is one of the most specific, but not the most common causes of infertility, which reduces the amount of pregnancy and poor results of pregnancy, such as preterm labor and abortion. The aim of this study was to evaluate the role of chronic endometritis in recurrent spontaneous abortions (RSA) and to determine the bilateral relationship between the histological and pathological findings of this inflammation. A case controlled-prospective observational study was performed on one hundred women 20-35 years in the Fatemeh Zahra infertility center and Rohani hospital. Patient group include forty patients with unexplained RSA and control group include 60 women that underwent hysteroscopy due to vaginal bleeding or other causes except RSA. All of the women underwent endometrial biopsy and examined by pathologist for presence plasma cells in stroma. In all patients endometritis rate was 8%. Patients with RSA had a significantly higher incidence of CE both hysteroscopically (30% vs. 6.7%; p<0.005) and pathologically (27.5% vs. 6.7%; p < 0.005). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of hysteroscopy in the diagnosis of CE were 93.3%, 97.6%, 87.5% and 98.8% respectively. Also the PPV and NPV of hysteroscopy, sensitivity, specificity in the diagnosis of endometrial polyp were 100%, 87.3%, 76.3% and 100% respectively. Based on the results, there was a significant association between CE and unexplained RSA. Due to high sensitivity and acceptable specificity of hysteroscopy in diagnosis of CE and endometrial polyp, we recommended hysteroscopic evaluation of patients with unexplained RSA.