Morphologic predictors of recurrent intrauterine synechiae in the reproductive age

• Mekan R. Orazov
• Lyudmila M. Mikhaleva
• Sevinc Ya. Ismayilzade

Abstract

Intrauterine synechiae (IUS) are characterised by endometrial fibrosis and can lead to menstrual and reproductive disorders. Despite the urgency of the problem of IUS, the mechanisms of development and recurrence of the disease are poorly understood. According to the literature, the incidence of pregnancy in patients with IUS is 22.5–33.3%, and the recurrence rate after treatment is 21–41.9%. Several data suggest a possible role of chronic endometrial inflammation in the progression of IUS fibrosis. Further investigation of the associations between chronic endometritis and IUS recurrence may contribute to optimising approaches to diagnosis, predicting the course and preventing recurrence of the disease.

The aim of the study was to develop methods of morphological prediction of recurrent intrauterine synechiae.

Material and methods. The study involved 127 patients of childbearing age who were diagnosed with intrauterine synechiae (according to the International Classification of Diseases, 10^th Revision, code N85.6). The age of the participants ranged from 27 to 43 years, with a mean age of 35.30±3.56. During the study, information about the patients’ previous diseases and conditions was collected, anthropometric parameters were measured, ultrasound imaging of the pelvic organs was performed, and endoscopic examination of the uterine cavity with targeted endometrial tissue sampling for histological analysis was conducted. The odds ratio calculation method was used for statistical data processing.

Results. Significant (p<0.05) morphological and IHC predictors of recurrence of intrauterine synechiae were: CD138-positive cells ≥5 count (OR 6.552; 95% CI 3.004 to 14.294), focal stromal fibrosis (OR 5.294; 95% CI 2.415 to 11.629), glandular collagenation (OR 5.600; 95% CI 1.52 to 20.612), stromal fibrosis (OR 4.515; 95% CI 1.404 to 14.502), spiral artery sclerosis (OR 3.143; 95% CI 1.310 to 7.539) and CD20-positive cells >0 count (OR, 2.772; 95% CI 1.052 to 7.302).

Conclusion. The results suggest a leading role of chronic inflammation and endometrial fibrosis in the pathogenesis of recurrent synechiae.

Keywords: intrauterine synechiae; recurrence; immunohistochemical; predictors

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