GynecologyGynecology2079-56962079-5831Consilium Medicum3349110.26442/20795696.2019.5.190735Research ArticleChronic endometritis: the state of the problem examinationDobrokhotovaIuliia ED. Sci. (Med.)-BorovkovaEkaterina ID. Sci. (Med.)katyanikitina@mail.ruSkal'naiaViktoriia Sobstetrician-gynecologist-BorovkovIvan MStudent-Pirogov Russian National Research Medical UniversityCity Clinical Hospital №40Sechenov First Moscow State Medical University (Sechenov University)15102019215495216042020Copyright © 2019, Consilium Medicum2019Chronic endometritis is a clinical morphological syndrome that develops as a result of a self-sustaining pathological process, which is based on a violation of the production of pro-inflammatory cytokines initiated by an infectious factor. The article presents the clinical and etiological classification of endometritis, the pathogenesis of development in terms of involvement of immunocompetent cells, standards for diagnosis and therapy.chronic endometritisinfertilityhabitual miscarriageplasma cellsimmunocomplex inflammationхронический эндометритбесплодиепривычное невынашивание беременностиплазматические клеткииммунокомплексное воспаление[Eckert L.O, Hawes S.E, Wölner-Hanssen P.K et al. Endometritis: the clinical-pathologic syndrome. Am J Obstet Gynecol 2002; 186: 690.][Шуршалина А.В. Хронический эндометрит как причина нарушений репродуктивной функции. Гинекология: журн. для практикующих врачей. 2012; 14 (4): 16-8. DOI: 10.1371/journal.pone.0214516][Johnston-MacAnanny E.B, Hartnett J, Engmann L.L et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010; 93: 437.][Kreisel K, Torrone E, Bernstein K et al. Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age - United States, 2013-2014. MMWR Morb Mortal Wkly Rep 2017; 66: 80.][Reekie J, Donovan B, Guy R et al. Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study. Clin Infect Dis 2018; 66: 437.][Westrom L, Mardh P.A. Epidemiology, etiology, and prognosis of acute salpingitis: A study of 1,457 laparoscopically verified cases. In: Nongonococcal Urethritis and Related Diseases, Hobson D, Holmes K.K (Eds), Am Soc Microbiol, Washington DC 1977; p. 84.][Sonnenberg P, Clifton S, Beddows S et al. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet 2013; 382: 1795.][Grimes D.A. Intrauterine device and upper-genital-tract infection. Lancet 2000; 356: 1013.][Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2017. Atlanta, GA: US Department of Health and Human Services; 2018.][Workowski K.A, Bolan G.A, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.][French C.E, Hughes G, Nicholson A et al. Estimation of the rate of pelvic inflammatory disease diagnoses: trends in England, 2000-2008. Sex Transm Dis 2011; 38: 158.][Srinivasan S, Hoffman N.G, Morgan M.T et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One 2012; 7: e37818.][Morré S.A, Karimi O, Ouburg S. Chlamydia trachomatis: identification of susceptibility markers for ocular and sexually transmitted infection by immunogenetics. FEMS Immunol Med Microbiol 2009; 55: 140.][Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2015. Atlanta, GA: US Department of Health and Human Services; October 2016.][Altunyurt S, Demir N, Posaci C. A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease. Eur J Obstet Gynecol Reprod Biol 2003; 107: 81.][Cicinelli E, De Ziegler D, Nicoletti R et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 2008; 89: 677.][Pitsos M, Skurnick J, Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis. J Reprod Med 2009; 54: 373.][Yudin M.H, Hillier S.L, Wiesenfeld H.C et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 318.][Kammerer U, Michael von Wolffb, Udo R. Markert Immunology of human endometrium Immunobiology 2004; 209: 569-74.][Доброхотова Ю.Э., Ганковская Л.Н., Боровкова Е.И. и др. Модулирование локальной экспрессии факторов врожденного иммунитета у пациенток с хроническим эндометритом и бесплодием. Акушерство и гинекология. 2019; 5: 125-32.][Haggerty C.L, Ness R.B, Amortegui A et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 141.][Propst A.M, Liberman R.F, Harlow B.L, Ginsburg E.S. Complications of hysteroscopic surgery: predicting patients at risk. Obstet Gynecol 2000; 96: 517.][Nair N, Camacho-Vanegas O, Rykunov D et al. Genomic Analysis of Uterine Lavage Fluid Detects Early Endometrial Cancers and Reveals a Prevalent Landscape of Driver Mutations in Women without Histopathologic Evidence of Cancer: A Prospective Cross-Sectional Study. PLoS Med 2016; 13: e1002206.][Maynard S.E, Venkatesha S, Thadhani R. Soluble Fms-like Tyrosine Kinase 1 and Endothelial Dysfunction in the Pathogenesis of Preeclampsia. Pediatr Res 2005; 57 (5 Pt 2): 1-7R.][Wagaarachchi P.T, Sirisena J. Efficiency of Pipelle device in sampling endometrium. Acta Obstet Gynecol Scand 2000; 79: 793.][Polena V, Mergui J.L, Zerat L, Sananes S. The role of Pipelle Mark II sampling in endometrial disease diagnosis. Eur J Obstet Gynecol Reprod Biol 2007; 134: 233.][Williams A.R, Brechin S, Porter A.J et al. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG 2008; 115: 1028.][Hirai Y, Sakamoto K, Fujiwara H et al. Liquid-based endometrial cytology using SurePath™ is not inferior to suction endometrial tissue biopsy for detecting endometrial malignancies: Midterm report of a multicentre study advocated by Japan Association of Obstetricians and Gynecologists. Cytopathology 2019; 30: 223.][McQueen D.B, Bernardi L.A, Stephenson M.D. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril 2014; 101: 1026.][ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol 2018; 131: e172.][APGO educational series on women's health issues. Clinical management of abnormal uterine bleeding. Association of Professors of Gynecology and Obstetrics, 2006.][ACOG Committee on Practice Bulletins - Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113: 1180. Reaffirmed 2016.][Cicinelli E, Resta L, Nicoletti R et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol 2005; 12: 514.][Cicinelli E, Resta L, Nicoletti R et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005; 20: 1386.][Grimes D.A, Schulz K.F. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database Syst Rev 2001: CD001327.][Eckert L.O, Thwin S.S, Hillier S.L et al. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol 2004; 190: 305.][www.who.int/gtb/publications/globrep/index.html (Accessed 3/7/05)][Зароченцева Н.В., Аршакян А.К., Меньшикова Н.С., Титченко Ю.П. Хронический эндометрит: этиология, клиника, диагностика, лечение. Рос. вестн. акушера-гинеколога. 2013; 5: 21-7.][Сухих Г.Т., Шуршалина А.В. Хронический эндометрит. М.: ГЭОТАР-Медиа, 2010.][Сидорова И.С., Макаров И.О., Унанян А.Л. Патогенез и патогенетически обоснованная терапия хронического эндометрита (клиническая лекция). Акушерство, гинекология и репродукция. 2010; 3: 21-4.]