Relationship of chronic endometritis with chronic deciduitis in cases of miscarriage

Abstract

Background: The presence of chronic deciduitis (CD) was determined in patients diagnosed with or without chronic endometritis (CE) before pregnancy.

Objective: To study the effect of CE on decidua in cases of miscarriage.

Methods: Decidual tissue was obtained from the patients who miscarried at the first pregnancy within a year after the diagnosis of the presence or absence of CE. The number and distribution pattern of plasma cells stained with CD138 in decidual tissue in 10 high-power fields (HPFs) was examined. The prevalence of CD diagnosed with four different grade; grade 0, no plasma cell in 10 HPFs, thus Non-CD;grade 1, rare single plasma cells; grade 2, rare clusters or more than 5 single cells total; and grade 3, many plasma cells with more than 5 clusters, were examined and compared between Non-CE and CE.

Results: The incidence rate of CD of grade2 + 3 was significantly higher in CE than Non-CE (53.8%; 7/13 vs. 0%; 0/13, P < 0.01). Presence of clusters or a number of plasma cells in 10 HPFs of decidua showed a sensitivity of 53.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.4% for the diagnosis of CE.

Conclusion: Presence of clusters of plasma cells or five or more of plasma cells in decidua was found in more than half of CE, but not found in Non-CE. When CD with cluster or five or more of plasma cells is confirmed histologically in miscarriage decidual tissue, the presence of CE before the pregnancy should be suspected.

Keywords: Chronic deciduitis; Chronic endometritis; Miscarriage.

Fig. 1

Immunohistochemistry of CD138 for decidual tissue. a No cells stained with CD138 are found in Non-CD. b. Grade 1 CD, one to 5 plasma cells found in 10 HPFs. c. Grade 2 CD, rare clusters or 5 to 20 plasma cells in 10 HPFs. d. Grade 3 CD, 20 or more plasma cells with more than 5 clusters in 10 HPFs. Bar = 100 μm

Fig. 2

The number of plasma cells in the decidual tissue in Non-CE and CE patients. The numbers of plasma cells (mean ± standard error) in 10 HPFs of decidual tissue is 0.52 ± 0.17 and 14.0 ± 5.88 (P < 0.01) in Non-CE and CE patients, respectively.