title: The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion.
abstract: OBJECTIVE
  We performed this study in order to investigate the role of chronic endometritis (CE) in unexplained recurrent spontaneous abortion (RSA) and to determine the correlation between hysteroscopic and histologic findings of CE in patients with unexplained RSA. We also tried to find out the relation between CE and primary vs. secondary RSA.
  
  
  METHODS
  One hundred and forty-two consecutive patients with unexplained RSA and 154 fertile women were enrolled in this study. All the patients and controls underwent hysteroscopy and, at the same time, endometrial biopsy. CE was suspected when hysteroscopy revealed signs of focal or diffuse endometrial hyperemia or endometrial endopolyps (less than 1mm in size). Histopathologic diagnosis of CE was based on superficial stromal edema, increased stromal density, and pleomorphic stromal inflammatory infiltrate dominated by lymphocytes and plasma cells. Results were compared between cases and controls as well as those with primary (n=61) and secondary (n=81) RSA.
  
  
  RESULTS
  Patients with RSA had a significantly higher incidence of CE both hysteroscopically (67.6% vs. 27.3%; p<0.0001) and pathologically (42.9% vs. 18.2%; p<0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy in the diagnosis of CE were found to be 98.4%, 56.23%, 63.5% and 97.82% respectively. Patients with secondary RSA had a higher prevalence of CE both pathologically (83.9% vs. 45.9%; p<0.0001) and hysteroscopically (58.1% vs. 24.6%; p<0.0001).
  
  
  CONCLUSIONS
  CE is associated with unexplained RSA. Hysteroscopy, with high sensitivity and acceptable specificity, is suitable for the diagnosis of CE in those with unexplained RSA. CE should be taken into consideration in those with secondary unexplained RSA.
authors.affiliation: Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Jaleh
authors.initials: J
authors.lastname: Zolghadri
authors.forename: Mozhdeh
authors.initials: M
authors.lastname: Momtahan
authors.forename: Khatereh
authors.initials: K
authors.lastname: Aminian
authors.forename: Fariborz
authors.initials: F
authors.lastname: Ghaffarpasand
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Tavana
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D002452:Cell Count; D004716:Endometritis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D006940:Hyperemia; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017154:Stromal Cells / Q000473:pathology; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult