Clinical and anamnestic data and morphofunctional characteristics of the endometrium in women with uterine developmental anomalies

Abstract

BACKGROUND: Uterine developmental anomalies have a negative impact on the implementation of female reproductive function, leading to a high risk of reproductive failures, premature birth, placental insufficiency, intrauterine growth retardation syndrome, labor anomalies and postpartum bleeding. The presence of both structural anomalies themselves and the high frequency of reproductive failures leads to repeated intrauterine interventions, which are considered as a premorbid background for the endometrial pathology development. Despite the combined causes of reproductive failure, morphological studies of the endometrium in women with various uterine anomalies are scarce.

AIM: The aim of this study was to evaluate the clinical and anamnestic data and morphological characteristics of the endometrium in women with uterine anomalies and reproductive failures in the anamnesis.

MATERIALS AND METHODS: We examined 123 women with uterine developmental anomalies (49 patients with an arcuate uterus, 38 patients with a uterine septum, 16 patients with a bicornuate uterus, 10 patients with an unicornuate uterus, 10 patients with dimetria). Standard clinical and laboratory work-up, hysteroscopy with endometrial biopsy and laparoscopy were performed in all patients. Histological and immunohistochemical examination of the endometrium was carried out according to the standard technique with assessment of the relevant receptor profile (estrogen and progesterone receptors) and pro-inflammatory markers (CD8⁺, CD20⁺, CD4⁺, and CD138⁺).

RESULTS: Clinical and anamnestic data evaluation in patients with uterine anomalies revealed menstrual abnormalities, commonly, dysmenorrhea. Regardless of the type of uterine anomaly, a high incidence of pelvic inflammatory disease, endometriosis and a high frequency of reproductive failures were found. The morphological structure of the endometrium with uterine anomalies was characterized by a higher frequency of endometrial hyperplasia, impaired secretory transformation and the presence of chronic endometritis.

CONCLUSIONS: Patients with a variety of uterine developmental anomalies are characterized by menstrual irregularities, a high incidence of gynecological pathology and reproductive failures. There is no association between pathognomonic signs of endometrial morphofunctional abnormalities and the type of uterine anomaly; however, they are similar to those seen in recurrent miscarriages and infertility of various origins.

Keywords

uterine malformation / defect / secretory endometrial transformation / chronic endometritis / reproductive loss

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