Dr. Ashish Vilas Jawarkar
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My friend tested positive for chronic endometritis following a biopsy. Her question is, what needs to be present in the tissue sample to conclude that the endometritis is the result of a miscarriage? What could be the other causative agents?
Hello,
Welcome to icliniq.com.
Conclusive proof for endometritis, following a miscarriage, would be the presence of villi and decidua in the biopsy. However, that may not be seen in most cases. Blood beta hCG levels in pregnancy range, just before the biopsy would suffice.
Patient's Query
Hello doctor,
Thank you for the reply. She had the miscarriage several years ago but just got the diagnosis now. So, she is assuming she got the chronic endometritis (CE) as a result of retained products of conception. After all these years, what is the likelihood that the diagnosis can be confirmed to have been caused by the miscarriage she had? Also, can an acute endometritis become chronic, if it is not treated at the time of infection? Can the biopsy confirm that the miscarriage happened several years ago?
Hello,
Welcome back to icliniq.com.
The retained products of conception would cause endometritis quite early. It will not stay symptomless for such a long time. Acute endometritis can turn chronic, but there will be symptoms. There are numerous causes of endometritis, and most of them can be treated with simple antibiotics. However, as I said, a blood beta hCG (human chorionic gonadotropin) level test would solve all your doubts. Hope that helped.
Patient's Query
Thank you doctor,
But, my question is, can the biopsy confirm that the chronic endometritis is a result of a miscarriage, after all these years? Or will the biopsy just show plasma cells which suggest chronic endometritis?
Hello,
Welcome back to icliniq.com.
To be specific, no, biopsy, years after the incident, cannot confirm a miscarriage. It can only suggest the diagnosis as chronic endometritis, without pointing to a specific cause.
Patient's Query
Thank you doctor,
Out of curiosity, what happens to the villi and decidua after these years? Do they just disappear? How come it does not show up in the biopsy? Also, to confirm, does the acute endometritis become chronic because it was not treated at the time?
Hello,
Welcome back to icliniq.com.
Villi and decidua must have shed off during one of the numerous menstrual periods she must have had in these years. Most probably, during the miscarriage, or the first one after the miscarriage. So, a biopsy done even immediately after the miscarriage may not show villi. Yes, acute endometritis becomes chronic if not treated in time.
Patient's Query
Thank you doctor,
If someone has had multiple miscarriages, does that show other causative agents in the biopsy, or would it be the same as one miscarriage? Again, let us assume that the biopsy is done several years after.
Hello,
Welcome back to icliniq.com.
In case of multiple miscarriages, a diagnostic curettage and a biopsy may be done after a series of blood tests, radiological tests, and other causes have been ruled out. The luteal phase defects and anatomical causes can be found out. However, no single test, including biopsy can provide a definite diagnosis, and the treating gynecologist has to take a call keeping all this in mind. I would advise a thorough gynecological evaluation and investigations as suggested by the doctor, rather than this haphazard approach.
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Pathology
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