CORRELATION RATIO OF CHRONIC ENDOMETRITIS WITH ANAMNESTIC FACTORS AND ULTRASOUND CHARACTERISTICS OF THE ENDOMETRIUM IN WOMEN OF REPRODUCTIVE AGE

Abstract

The diagnosis of chronic endometritis is problematic because of its asymptomatic course and the need for invasive uterine procedures to confi rm the diagnosis histologically. Therefore, it is important to identify factors that indicate a high risk of this condition. Aim: The aim of this study is to identify factors that have a statistically signifi cant correlation with the presence of CE in women of reproductive age and to validate them by histologic examination of the endometrium. Material and Methods. A retrospective analysis of 400 histories of women of reproductive age who underwent hysteroscopy and endometrial biopsy for histologic examination was performed. Histologically, 154 women (38.5 %) were found to have chronic endometritis (the group of women with chronic endometritis), while 246 women (61.5 %) were found to have other conditions unrelated to chronic endometritis (the group of women without chronic endometritis). Analysis of anamnestic factors and ultrasound criteria associated with an increased likelihood of chronic endometritis was performed when comparing data from women in these groups. The strength of the relationship between these factors on the one hand and the development of chronic endometritis on the other hand was assessed by calculating the Kendall’s τ (tau) rank correlation coeffi cient. The strength of the relationship between the mentioned factor and CE was considered strong (+++) with a τ coeffi cient of 0.5 or higher, moderate (++) with a τ coeffi cient in the range of 0.2 to 0.499, weak (+) with a τ coeffi cient in the range of 0.1 to 0.199. A τ-coeffi cient value between 0 and 0.099 indicated no correlation between the factor and chronic endometritis. The study was conducted in accordance with the principles of patient- centered care, the requirements of the Tokyo Declaration of the World Medical Association, the international recommendations of the Helsinki Declaration of Human Rights, the Convention of the Council of Europe on Human Rights and Biomedicine, the laws of Ukraine, and the Code of Ethics of the Ukrainian Physician. The paper is an excerpt from the initiative scientifi c research project of the Department of Obstetrics and Gynecology No. 2 at Poltava State Medical University, entitled «Optimization of approaches to the management of pregnancy in women at high risk of obstetric and perinatal pathology» (State registration number 0122U201228, duration: 10.2022-09.2027) in collaboration with the Department of Pathological Physiology at Poltava State Medical University. Results and Discussion. The determination of the correlation coeffi cient allowed us to identify the factors with the strongest association with chronic endometritis. Among them are 5 infectious factors: cervicitis in the past medical history (τ coeffi cient 0.625245229; p<0.0000000001); chronic infl ammation of the uterine appendages (τ coeffi cient 0.522536031; p<0.0000000001); sexually transmitted diseases in the past medical history (τ coeffi cient 0.547218916; p<0.0000000001); chronic urogenital infl ammatory diseases in the sexual partner (τ coeffi cient 0. 529314979; p<0.0000000001); previous multiple use of intrauterine contraception (τ-coeffi cient 0.502383401; p<0.0000000001); 4 symptomatic consequential factors: infertility in past medical history (τ-coeffi cient 0.683492482; p<0.0000000001); missed miscarriages in past medical history (τ-coeffi cient 0. 644489429; p<0.0000000001); recurrent early pregnancy loss (τ-coeffi cient 0.625942138; p<0.0000000001); abnormal uterine bleeding (τ-coeffi cient 0.650850348; p<0.0000000001); and 4 ultrasound criteria, such as the presence of local endometrial thickening in the form of a polyp (τ-coeffi cient 0.641820318; p<0. 0000000001); increased echogenicity of the endometrium (τ-coeffi cient 0.665249637; p<0.0000000001); heterogeneity of the endometrial echo structure with areas of increased and decreased echogenicity (τ-coeffi cient 0.693152163; p<0.0000000001); hyperechogenic structures in the basal layer of the endometrium (τ-coeffi cient 0.521658745; p<0.0000000001). In our opinion, the combination of an infectious or symptomatic factor with an ultrasound criterion indicates a high probability of chronic endometritis. In the absence of ultrasound signs, the combination of 1 infectious and 1 symptomatic- consequential factor indicates a high risk of chronic endometritis. To confirm the representativeness of this method, we analyzed endometrial biopsies obtained by curettage in 100 women with this combination of factors. The diagnosis was confi rmed histologically in 87 women. Conclusion. Our proposed assessment of high-risk criteria for chronic endometritis, based on the combination of infectious, symptomatic- consequential, and ultrasound criteria, allows predicting the presence of this pathology in 87 % of patients withoutтthe need for invasive interventions. This helps to improve patient selection for hysteroscopy and avoid unnecessary uterine interventions in the diagnosis of chronic endometritis in women planning pregnancy.

Keywords

• Chronic Endometriosis; Anamnestic Factors; Ultrasound diagnostics