Article

Chronic endometritis: Correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies

Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, Bari, Italy.
Fertility and sterility (Impact Factor: 4.59). 04/2008; 89(3):677-84. DOI: 10.1016/j.fertnstert.2007.03.074
Source: PubMed

ABSTRACT

To evaluate the type and etiopathogenic role of infectious agents detected in endometrial cultures obtained from women with chronic endometritis (CE).
Prospective controlled study.
University hospital.
2190 women undergoing hysteroscopy for different indications.
Vaginal and endometrial samples were collected from 438 women with a CE diagnosis at hysteroscopy and 100 women with no signs of CE (controls).
Histology and cultures for common bacteria, Neisseria gonorrhoeae and Mycoplasma, and molecular biology testing for Chlamydia were performed.
We compared results of vaginal and intrauterine cultures obtained from women with and without CE. Histologic results were positive in 388 of these cases (88.6%), and at least one microorganism was found in 320 endometrial samples (73.1%). In the control group, histologic results and endometrial culture were positive in only 6% and 5% of cases, respectively. The most frequent infectious agents detected at the endometrial level were common bacteria (58% of cases). Ureaplasma urealyticum was detected in 10% and Chlamydia in only 2.7% of positive endometrial cultures. In only 143 (32.6%) cases were the same infectious agent isolated in endometrial and vaginal cultures.
More than 70% of CE cases resulted from nongonococcal, nonchlamydial infections. Common bacteria and Mycoplasma were the most frequent etiologic agents. Vaginal cultures have low concordance with endometrial cultures.

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    • "This allows us to speculate that the hysteroscopic evaluation of the endometrial inflammatory disease could have a higher sensitivity than the endometrial cultures in detecting CE, and that a normal endometrial pattern at hysteroscopy could be more accurate in predicting the possibility of a successful pregnancy after IVF. When considering the problem of the cost effectiveness and the risk benefit of our approach to diagnosis and treatment of CE, we underline that fluid mini-hysteroscopy is a minimally invasive technique that can be performed in an office setting without anesthesia (Cicinelli et al., 2008), so that the advantages in terms of diagnosis and treatment amply overcome the costs of the procedure. Moreover, in case of persistent CE no more than three cycles of treatment were performed so, although we cannot exclude the possibility to generate antibiotic resistance , the potential benefit for patients outweighs the risk. "
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    ABSTRACT: What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome?
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    • "When clinical symptoms, HYS findings and H and E, staining of endometrium suggest infection, a check for the presence of plasma cells is important to confirm a diagnosis of endometritis. Special immuno-histochemical stain for Syndecan 1, a proteoglycan present on the surface of plasma cells makes an accurate diagnosis of endometritis as the cause of AUB.[38] "
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    ABSTRACT: Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, office vacuum aspiration (Pipelle) and the use of office hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of finding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-à-vis each other. Histological assessment is the final word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Ca. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. A single-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the office hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.
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    • "In studies investigating women with chronic endometritis, Cicinelli et al.,. (Cicinelli et al., 2008) reported isolation aerobic bacteria in over 73% of cases in symptomatic women but in only 5% of women without clinical evidence of endometritis. A shortcoming if their study was that they did not screen endometrial samples for the presence of anaerobes, which dominate the genital microflora. "

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