Chronic endometritis in women with recurrent early pregnancy loss and or fetal demise

Capsule:
There was a high prevalence of chronic endometritis in a cohort of 395 women with pregnancy loss. “Test of cure” was 100% with antibiotics. Subsequent live-birth rates were encouraging.

Authors:
Dana B. McQueen, M.D., Lia A. Bernardi, M.D., Mary D. Stephenson, M.D., M.Sc.

Volume 101, Issue 4, Pages 1026-1030

Abstract:

Objective:
To assess the prevalence of chronic endometritis in women with a history of recurrent early pregnancy loss (REPL) and/or fetal demise (FD).

Design:
Observational cohort study using prospectively collected data.

Setting:
Recurrent pregnancy loss program in an academic medical center.

Patient(s):
Three hundred ninety-five women with a history of two or more pregnancy losses of less than 10 weeks’ size or a fetal demise of 10 or more weeks’ size.

Intervention(s):
All women had an endometrial biopsy. Chronic endometritis was treated with antibiotics, and a second endometrial biopsy was recommended as a “test of cure.”

Main Outcome Measure(s):
Subsequent live-birth rate (LBR).

Result(s):
The overall prevalence of chronic endometritis was 9% (35/395) in this cohort; 7% (21/285) in the REPL group, 14% (8/57) in the FD group, and 11% (6/53) in the combined REPL/FD group. The cure rate was 100% after a course(s) of antibiotics. The subsequent cumulative LBR was 88% (21/24) for the treated chronic endometritis group versus 74% (180/244) for the group without chronic endometritis. The per-pregnancy LBR for the treated chronic endometritis group was 7% (7/98) before treatment versus 56% (28/50) after treatment.

Conclusion(s):
There was a high prevalence of chronic endometritis in this cohort. The test of cure was 100% with antibiotics. Subsequent LBRs after treatment were encouraging.

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