Comprehensive study of the endometrium of women with reproductive disorders, and chronic endometritis

Abstract

UDC: 618.14-002 The study of the endometrium and the development of new methods of rehabilitation therapy for women with reproductive disorders is important issue in modern obstetrics. Violations of the proliferative activity of the endometrium, the presence of persistent infection and changes in local immunity are the main causes of obstetric and perinatal complications (Adamian and Kulakov, 1997; Donders, Van Bulek, Caudron et al., 2000; Vikhlyaeva, 2002). The aim of this work was studying the hysteroscopic endometrium and its integrated study (immunological, histological, bacteriological and PCR) of 84 patients with a violation of the reproductive function to determine the role of persistent mycoplasma infection. Endoscopic exploration of the uterine cavity was carried out using the “KARL STORZ” (Germany). We used saline solution as the liquid medium. After removing the polyps, polypoid formations and doing endometrial sampling for the immunological, histological, bacteriological and PCR study, we carried out a hysteroscopic control research, which made it possible to evaluate the effectiveness of the operation. A visual study of the uterus showed that the endometrium had no pathology and corresponded to the phase of the menstrual cycle in 26.2% of cases and other 73.8% revealed various pathologies of the endometrium. Herewith, the most common pathology of endometrium were various hyperplastic processes (in 70.9% of cases - glandular and glandular-fibrous hyperplasia, various types of polyps). We noticed the endoscopic differences between the fibrous and glandular polyps, which were appearing in different sizes and shapes of polyps localization. With hysteroscopy, fibrous polyps were often determined as a single pale formation of round or oval shape, with a small size (0.5 cm). Most polyps were located in the bottom of the uterus, near the ostium of the uterine tubes. Glandular polyps, in contrast to fibrous were larger in size (0.5 to 5-6 cm) and in most cases were multiple. The colors of the polyps were pale-pink and gray-pink; the tip of the polyp - a dark purple or blue-purple color. We spotted vessels in the shape of capillary net on the surface of the polyp. The symptoms of chronic endometritis were characterized by increased vascular pattern, edema and focal hyperemia of the endometrium, which were noted in 19.04% of cases. In about the same percentage of cases we revealed endometriosis of the uterus - 2.4% and intrauterine adhesions - 2.4%. With adenomyosis, the endoscopy took form of the “eyes” of dark-purple color on the background of relief of the uterine walls. Upon detection of intrauterine synechia: the uterus is divided by vertical spikes of whitish color, the volume of the cavity is reduced.