Screen for Endometritis After Repeated Pregnancy Loss or Fetal Death: Study

By Lorraine L. Janeczko

February 19, 2014

NEW YORK (Reuters Health) - Fertility specialists treating women who've had repeated pregnancy loss or a fetal death should consider screening and treating them for chronic endometritis, new research shows.

"The endometrial biopsy should be part of a standard diagnostic evaluation for recurrent pregnancy loss or fetal demise" in these women who have a "devastating reproductive history," said principal investigator Dr. Mary D. Stephenson, from the University of Illinois College of Medicine in Chicago, in an email to Reuters Health.

In what Dr. Stephenson called the first published investigation to determine the prevalence of chronic endometritis as well as the improvement in live birth rates after a course of antibiotics in these women, she and her colleagues conducted an observational cohort study using prospectively collected data.

They looked at 395 women with a history of two or more pregnancy losses of under 10 weeks' size or a fetal death of 10 or more weeks' size who were in a program to treat recurrent pregnancy loss.

All women underwent an endometrial biopsy. Those with chronic endometritis - defined by the presence of plasma cells on biopsy - were treated with antibiotics and offered a second endometrial biopsy for a test of cure. Those with persistent chronic endometritis were offered a second course of antibiotics.

The overall prevalence of chronic endometritis was 9% (35 of 395 women), including 7% (21 of 285 women) with recurrent early pregnancy losses, 14% (eight of 57 women) with a history of fetal demise, and 11% (six of 53 women) with both.

Women with chronic endometritis had a higher mean number of fetal deaths compared with women without chronic endometritis (0.9 vs. 0.4 fetal deaths; P=0.001).

The mean number of early pregnancy losses, dilation and curettage history, and pregnancy termination history were not statistically different between women with and without chronic endometritis. The groups were also similar in terms of race, body mass index, history of infertility, number of prior live births, and age at prior losses and live births.

After treatment with antibiotics, the endometritis cure rate was 100%, the researchers reported online January 24 in Fertility and Sterility.

The subsequent cumulative live-birth rate was 88% (21 of 24 women) for those treated for chronic endometritis compared with 74% (180 of 244 women) for those without chronic endometritis (P=0.215).

The overall per-pregnancy live-birth rate for the treated group was 7% (seven of 98 pregnancies) before treatment compared with 56% (28 of 50 pregnancies) after treatment (P<0.001).

Women without chronic endometritis also showed a significant increase in per-pregnancy live-birth rate from 15% (150 of 1,020 pregnancies) before evaluation to 59% (212 of 362 pregnancies) after evaluation (P<0.001).

While both groups increased their per-pregnancy subsequent live-birth rate, the women with treated chronic endometritis showed a significantly greater change (P=0.04).

The index pregnancy outcomes immediately following antibiotic treatment were similar between groups, with a live-birth rate of 42% (10 of 24 pregnancies) in women with treated chronic endometritis and 59% (143 of 244 pregnancies) in women without chronic endometritis (P=0.11).

"I am not surprised with the results, considering the possibility of retained pregnancy tissue following pregnancy loss. With the publication of this study, we now have evidence to support our hypothesis," Dr. Stephenson said.

"Due to the lack of consensus regarding treatment of chronic endometritis, studies are needed to assess the optimal antibiotics, dose and duration of treatment, along with 'test of cure,'" she said.


Fertil Steril 2014


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