L.I. MALTSEVA, R.I. SHARIPOVA, M.E. ZHELEZOVA

Kazan State Medical Academy ― Branch Campus of the FSBEI FPE RMACPE MOH Russia, 36 Butlerov Str., Kazan, Russian Federation, 420012

Maltseva L.I. ― D. Sc. (medicine), Professor, Head of the Department of Obstetrics and Gynecology №1, tel. +7-905-314-40-51, e-mail: laramalc@mail.ru

Sharipova R.I. ― applicant of the Department of Obstetrics and Gynecology №1, tel. +7-962-550-86-33, e-mail: rezedusha@mail.ru

Zhelezova M.E. ― PhD (medicine), Associate Professor of the Department of Obstetrics and Gynecology №1, tel. +7-919-627-13-66, e-mail: gelezovam@gmail.com, ORCID ID: 0000-0002-2006-0110

Chronic endometritis remains an urgent problem of modern reproduction science, leading to infertility, failures of auxiliary technologies, miscarriage and various obstetric complications. The objective of this review was to assess the shift of representations paradigm, which previously considered uterine cavity sterile, and the new definitions of chronic endometritis. The analysis of literature data for the last five years was performed, using the main electronic search engines. The review reflects the frequency of chronic endometritis, microbiological and diagnostic characteristics of the process. The attention is focused on the diagnostic difficulties and shortcomings of classical diagnostic methods ― morphological research and cultural method. An alternative point of view on these issues is presented. The necessity and high efficiency of antibacterial therapy of chronic endometritis as the main component of treatment are shown.

Key words: uterine microbiome, chronic endometritis, endometrium, viral-bacterial flora.

(For citation: Maltseva L.I., Sharipova R.I., Zhelezova M.E. Chronic endometritis ― changing conventional thinking. Practical Medicine. 2018)

REFERENCES

1. Globalʹnaya strategiya okhrany zdorovʹya zhenshchin, detey i podrostkov (2016-2030 gg.) [Global strategy for the health of women, children and adolescents (2016-2030)], available at: www.who.int
2. Malʹtseva L.I., Smolina G.R., Yupatov E.Yu. Chronic endometritis and pelvic pain. Akusherstvo. Ginekologiya. Reproduktsiya, 2012, no. 3, pp. 23-27 (in Russ.).
3. Sukhikh G.T., Shurshalina A.V. Khronicheskiy ehndometrit: rukovodstvo [Chronic endometritis: a guide]. Moscow: GEHOTAR-Media, 2013. 64 p. (Biblioteka vracha-spetsialista).
4. Kuznetsova I.V., Zemlina N.S., Rashidov T.N. Chronic endometritis as an outcome of an infectious inflammatory disease of the uterus. Ginekologiya, 2016, vol. 18, no. 2, pp. 44-50.
5. Ovcharuk Eh.A. Chronic autoimmune endometritis as one of the main causes of impaired reproductive function. Vestnik novykh meditsinskikh tekhnologiy: ehlektronnyy zhurnal, 2013, no. 1, pp. 224-225 (in Russ.).
6. Kitaya K., Matsubayashi H., Yamaguchi K. et al. Chronic Endometritis: potential cause of infertility and obstetric and neonatal complications. Am. J. Reprod. Immunol, 2016, vol. 75, no. 1, pp. 13-22.
7. Wu D., Kimura F., Zheng L. et al. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod. Biol. Endocrinol, 2017, vol. 15, no. 1, p. 16.
8. Park H.J., Kim Y.S., Yoon T.K., Lee W.S. Chronic endometritis and infertility. Clin. Exp. Reprod. Med, 2016, vol. 43, no. 41, pp. 85-192.
9. Malʹtseva L.I., Sharipova R.I., Tsyplakov D.Eh., Zhelezova M.E. Morphofunctional state of the endometrium in women with bacterial viral endometritis. Prakticheskaya meditsina, 2017, no. 7, pp. 87-91 (in Russ.).
10. Gombolevskaya N.A. Sovershenstvovanie diagnostiki i terapii khronicheskogo ehndometrita u zhenshchin v reproduktivnom periode: avtoref. dis. … kand. med. nauk [Improving the diagnosis and treatment of chronic endometritis in women in the reproductive period. Synopsis of dis. PhD med. sciences]. Moscow, 2016. 25 p.
11. Danusevich I.N. The frequency of occurrence of chronic endometritis in women with different types of reproductive disorders. Byulletenʹ VSNTS SO RAMN, 2013, no. 4, pp. 18-20 (in Russ.).
12. Devyatova E.A., Tsaturova K.A., Vartanyan E.V. Estimation of the probability of implantation success in vitro fertilization. Doktor.Ru, 2016, no. 7, pp. 34-38 (in Russ.).
13. Shurshalina A.V. Chronic endometritis: a modern view of the problem. Consilium Medicum, 2011, vol. 13, no. 6, pp. 36-39 (in Russ.).
14. Cicinelli E., Matteo M., Tinelli R. et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction, 2015, 30, pp. 323-30.
15. Romero R., Espinoza J., Mazor M. Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril, 2004, 82, pp. 799-804.
16. Bouet P.E., El Hachem H., Monceau E. et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril, 2016, 105, pp. 106-110.
17. Kitaya K., Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am. J. ReprodImmunol, 2011, vol. 66, no. 5, pp. 410-415.
18. Ginekologiya: Natsionalʹnoe rukovodstvo, pod red. V.I. Kulakova, G.M. Savelʹevoy, I.B. Manukhina [Gynecology: National leadership. Ed. by V.I. Kulakov, G.M. Saveleva, I.B. Manukhin]. Moscow, 2009. 1150 p.
19. Inmaculada Moreno, Francisco M. Codoñer, Felipe Vilella et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. American Journal of Obstetrics and Gynecology, 2016, 215 (6), p. 684.
20. Perez-Muñoz M.E., Arrieta M.C., Ramer-Tait A.E. et al. A critical assessment of the «sterile womb» and «in utero colonization» hypotheses: implications for research on the pioneer infant microbiome. Microbiome, 2017, vol. 5, no. 1, p. 48.
21. Mitchell C.M., Haick A., Nkwopara E., et al. Colonization of the upper genital tract by vaginal bacterial species in nonpregnant women. Am. J. Obstet. Gynecol, 2015, 212, 611, pp. 611-619.
22. Verstraelen H., Vilchez-Vargas R., Desimpel F. et al. Characterisation of the human uterine microbiome in non-pregnant women through deep sequencing of the V1-2 region of the 16S rRNA gene. Peer J, 2016, 4, p. e1602.
23. Chen C., Song X., Wei W. et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat. Commun, 2017, vol. 8, no. 1, pp. 875.
24. Younes J.A., Lievens E., Hummelen R. et al. Women and their Microbes: The Unexpected Friendship. Trends Microbiol, 2018, vol. 26, no. 1, pp. 16-32.
25. Stout M.J., Conlon B., Landeau M. et al. Identification of intracellular bacteria in the basal plate of the human placenta in term and preterm gestations. Am. J. Obstet Gynecol, 2013, vol. 208, pp. 221-227.
26. Payne M.S., Bayatibojakhi S. Exploring preterm birth as a polymicrobial disease: an overview of the uterine microbiome. Front. Immunol, 2014, vol. 27, no. 5, p. 595.
27. Fardini Y., Chung P., Dumm R., et al. Transmission of diverse oral bacteria to murine placenta: evidence for the oral microbiome as a potential source of intrauterine infection? Infect. Immun, 2010, 78 (4), pp. 1789-96.10.1128/IAI.01395-09
28. Moreno I., Cicinelli E., Garcia-Grau I. et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology, available at: www.ajorg.org (American Journal of Obstetrics & Gynecology, 2018, 22 February).
29. Rui-Li Fang, Lin-Xing Chen, Wen-Sheng Shu et al. Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps. Am. J. Transl. Res., 2016, 8 (3), pp. 1581-1592.
30. Greenwood S.M., Moran J.J. Chronic endometritis: morphologic and clinical observations. Obstet. Gynecol, 1981, 58, pp. 176-84.
31. Andrews W.W., Goldenberg R.L., Hauth J.C., et al. Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery. Am. J. Obstet. Gynecol, 2005, 193, pp. 739-745.
32. Reza Peymani and Alan De Cherney. Microbiome, Infection and Inflammation in Infertility, 2016. Genital Infections and Infertility At ef Darwish, Intech Open, DOI: 10.5772/63090.
33. Adegboyega P.A., Pei Y., McLarty J. Relationship between eosinophils and chronic endometritis. Hum. Pathol, 2010, 41, pp. 33-37.
34. Cicinelli E., Resta L., Nicoletti R., et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Human Reproduction, 2005, 20, pp. 1386-9.
35. Cicinelli E., Matteo M., Tinelli R., et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod. Sci, 2014, vol. 21, pp. 640-647.
36. Klinicheskie rekomendatsii MZ RF 2016 ― poslerodovyy ehndometrit [Clinical recommendations of the Ministry of health of the Russian Federation 2016 — postpartum endometritis], available at: https://medi.ru/klinicheskie-rekomendatsii/poslerodovyj-endometrit_14195
37. Ness R.B., Soper D.E., Holley R.L., et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial. Am. J. Obstet. Gynecol, 2002, 186 (5), pp. 929-937.