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.

  • Melissa

    I am 36 years old with 4 children! When my last child was a year old, my husband and I tried for a fifth child. As with my first 4, I had no problems getting pregnant. However I have miscarried 3 babies all in the second trimester in the last year and a half. I have had retained products with all three miscarriages leading doc to think I was having a placentation problem. Chronic endometritis was found after the second miscarriage when pathology was done on retained products. I the doc never treated me for that inflammation. She thought it would go away in the retained products were removed. After that I lost baby#3 at 16 weeks. I asked to then be treated after I found this research. Oddly enough, some bowel/ period pain I used to experience is now gone-. A hysterectomy was done after I was then treated with doxycycline for 14 days. I am not sure if they specifically looked for endometritis but the doc said my uterus looked good except that retained products were again found…3 months after delivery. I requested to be treated with antibiotics again knowing the roof could cause the inflammation to linger. I am now on a 3 week course to be safe. Do I need to have a biopsy done for proof of cure and do you think my miscarriages were likely due to this? Looking back I believe it is possible that inflammation could have started after the delivery of my 3rd child who is now 6. If that is true, what is the likely hood I will be healed and ever be able to carry another baby?

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