Ukrainian Journal of Perinatology and Pediatrics. 2024. 3(99): 61-66. doi: 10.15574/PP.2024.3(99).6166
Bodashevska K. D.¹, Sukhanova A. A.¹, Taran О. А.², Lastovetska O. B.³, Bodnarchuk O. V.³, Belinsky A. V.³, Vozniuk A. V. ^2
1Shupyk National Healthcare University of Ukraine, Kyiv
²National Pirogov Memorial Medical University, Vinnytsia, Ukraine
³Vinnytsia Regional Hospital named after M.I. Pirogov, Ukraine

For citation: Bodashevska KD, Sukhanova AA, Taran ОА, Lastovetska OB, Bodnarchuk OV, Belinsky AV, Vozniuk AV. (2024). Assessment of risk factors for chronic endometritis after early artificial abortion. Ukrainian Journal of Perinatology and Pediatrics. 3(99): 61-66. doi: 10.15574/PP.2024.3(99).6166.
Article received: Apr 15, 2024. Accepted for publication: Sep 04, 2024.

The frequency of inflammatory postabortion diseases, which have turned into a chronic form, ranges from 14.6% to 19.2% and is often the cause of reproductive health disorders in young women.
Aim – to investigate risk factors for the development of chronic endometritis after early abortions.
Materials and methods. A cohort study was conducted, in which 119 women aged 18 to 45 years (on average – 29.63±5.75 years) took part: I group – 19 women with developed chronic endometritis after artificial abortion, II group – 100 women with the physiological course of the postabortion period. Analysis of anamnestic data, results of clinical laboratory and instrumental research was carried out. Statistical data processing was carried out using the SPSS 21 program.
Results. According to the results of multivariate regression analysis, significant risk factors for the development of chronic endometritis after artificial abortion in the early stages are: age ≥30 years, presence of obesity, anemia, previous abortion(s) in the anamnesis, III-IV degree of vaginal contents purity, due date abortion > 9 weeks, retention of fetal egg elements after termination of the current pregnancy.
Conclusions. On the basis of the identified clinical and anamnestic risk factors for chronic postabortion endometritis, it is advisable to single out a high-risk group in order to increase the effectiveness of treatment and preventive measures to avoid possible negative consequences for the reproductive women’s health after early termination of pregnancy.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Keywords: chronic endometritis, artificial abortion, risk factors.
REFERENCES

1. Addante AN, Eisenberg DL, Valentine MC, Leonard J, Maddox KEJ, Hoofnagle MH. (2021). The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017. Contraception. 104(5): 496-501. https://doi.org/10.1016/j.contraception.2021.03.018

2. Akhmadalieva NZh. (2023). Diagnosis of reproductive function disorders in women who have undergone post-abortion endometritis by modern methods. Еkonomika ta sotsium. 10(113); 2: 511-517.

3. Bearak J, Popinchalk A, Ganatra B, Moller AB, Tunçalp Ö, Beavin C et al. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health. 8(9): e1152-e1161. https://doi.org/10.1016/S2214-109X(20)30315-6; PMid:32710833

4. Bodashevska KD. (2024). The influence of artificial abortions on the reproductive health state of fertile women. Results of a cohort study. Ukrainian Journal Health of Woman. 2(171): 57-62; https://doi.org/10.15574/HW.2024.171.57

5. Bullough C, Meda N, Makowiecka K, Ronsmans C, Achadi EL, Hussein J. (2005). Current strategies for the reduction of maternal mortality. BJOG. 112(9): 1180-1188. https://doi.org/10.1111/j.1471-0528.2005.00718.x

6. Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U et al. (2015). Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 30(2): 323-330. https://doi.org/10.1093/humrep/deu292; PMid:25385744

7. Garry R, Hart R, Karthigasu KA, Burke C. (2010). Structural changes in endometrial basal glands during menstruation. BJOG. 117(10): 1175-1185. https://doi.org/10.1111/j.1471-0528.2010.02630.x; PMid:20560946

8. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. (2009, Mar 25). The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 9: 88. https://doi.org/10.1186/1471-2458-9-88; PMid:19320986 PMCid:PMC2667420

9. Jatlaoui TC, Boutot ME, Mandel MG, Whiteman MK, Ti A et al. (2020). Abortion Surveillance – United States, 2015. MMWR Surveill Summ. 67(13): 1-45. https://doi.org/10.15585/mmwr.ss6713a1

10. Jiang C, Liu C, Guo J, Chen L, Luo N, Qu X et al. (2017). The Expression of Toll-like receptors in eutopic and ectopic endometrium and its implication in the inflammatory pathogenesis of adenomyosis. Sci Rep. 7(1): 7365. https://doi.org/10.1038/s41598-017-07859-5; PMid:28779087

11. Johnston-Macananny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. (2010). Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 93(2): 437-441. https://doi.org/10.1016/j.fertnstert.2008.12.131; PMid:19217098

12. Kortsmit K, Jatlaoui TC, Mandel MG, Reeves JA, Oduyebo T et al. (2020). Abortion Surveillance – United States, 2018. MMWR Surveill Summ. 69(7): 1-29. https://doi.org/10.15585/mmwr.ss6907a1; PMCid:PMC7713711

13. Lash GE, Naruse K, Robson A, Innes BA, Searle RF et al. (2011). Interaction between uterine natural killer cells and extravillous trophoblast cells: effect on cytokine and angiogenic growth factor production. Hum Reprod. 26(9): 2289-2295. https://doi.org/10.1093/humrep/der198; PMid:21685139

14. Li J, Wei J, Chen S, Wang X, Chen J, Zeng D, Fan L. (2024). Prevalence and risk factors for chronic endometritis in patients with adenomyosis and infertility: a retrospective cohort study. BMC Womens Health. 24(1): 403. https://doi.org/10.1186/s12905-024-03245-2

15. Meresman GF, Olivares C, Vighi S, Alfie M, Irigoyen M, Etchepareborda JJ. (2010). Apoptosis is increased and cell proliferation is decreased in out-of-phase endometria from infertile and recurrent abortion patients. Reprod Biol Endocrinol. 8: 126. https://doi.org/10.1186/1477-7827-8-126; PMid:20969784 PMCid:PMC2987946

16. Piltonen T, Puurunen J, Hedberg P, Ruokonen A, Mutt SJ, Herzig KH et al. (2012). Oral, transdermal and vaginal combined contraceptives induce an increase in markers of chronic inflammation and impair insulin sensitivity in young healthy normal-weight women: a randomized study. Hum Reprod. 27(10): 3046-3056. https://doi.org/10.1093/humrep/des225

17. Pinto V, Matteo M, Tinelli R, Mitola PC, De Ziegler D, Cicinelli E. (2015). Altered uterine contractility in women with chronic endometritis. Fertil Steril. 103(4): 1049-1052. https://doi.org/10.1016/j.fertnstert.2015.01.007; PMid:25681852

18. Pirtea P, Cicinelli E, De Nola R, de Ziegler D, Ayoubi JM. (2021). Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis. Fertil Steril. 115(3): 546-560. https://doi.org/10.1016/j.fertnstert.2020.12.010; PMid:33581856

19. Podolsky VlV. (2013). Abort ta yoho naslidky dlia reproduktyvnoho zdorovia u zhinok fertylnoho viku. Zdorove zhenshchyni. 10(86): 32-34. https://doi.org/10.1111/j.1740-9713.2013.00664.x

20. Upadhyay UD, Desai S, Zlidar V, Weitz TA, Grossman D, Anderson P, Taylor D. (2015). Incidence of emergency department visits and complications after abortion. Obstet Gynecol. 125(1): 175-183. https://doi.org/10.1097/AOG.0000000000000603

21. Upadhyay UD, Johns NE, Barron R, Cartwright AF, Tapé C, Mierjeski A, McGregor AJ. (2018). Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample. BMC Med. 16(1): 88. https://doi.org/10.1186/s12916-018-1072-0

22. Wiesenfeld HC, Hillier SL, Krohn MA, Amortegui AJ, Heine RP, Landers DV, Sweet RL. (2002). Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 100(3): 456-463. https://doi.org/10.1016/S0029-7844(02)02118-X; PMid:12220764

23. Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z. (2011). The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol. 155(2): 217-220. https://doi.org/10.1016/j.ejogrb.2010.12.010; PMid:21232841