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Quantifying CD138+ cells in the endometrium to assess chronic endometritis in women at risk of recurrent pregnancy loss : a prospective cohort study and rapid review
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Rimmer, Michael P., Fishwick, Katherine, Henderson, Ian, Chinn, David, Al Wattar, Bassel H. and Quenby, Siobhan (2021) Quantifying CD138+ cells in the endometrium to assess chronic endometritis in women at risk of recurrent pregnancy loss : a prospective cohort study and rapid review. Journal of Obstetrics and Gynaecology Research . doi:10.1111/jog.14585 (In Press)
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Official URL: http://dx.doi.org/10.1111/jog.14585
Abstract
Objective: To determine the value of uterine CD138+ cells, as a marker of chronic endometritis, in predicting subsequent reproductive outcome in women with history of recurrent pregnancy loss.
Design: A prospective longitudinal study.
Setting: Tertiary specialised clinic.
Patients: Women with history of recurrent pregnancy loss or implantation failure over a 12-months follow-up period.
Intervention: We quantified the CD138+ cells/high powered field (hpf) using immunohistochemistry and image analysis of endometrial biopsies obtained during the secretory stage post ovulation.
Main Outcome Measures: live birth and subsequent pregnancy loss. We calculated the receiver operator curve for predicting subsequent pregnancy loss and reported using relative risk (RR) and 95% confidence intervals (CI).
Results: We enrolled 344 women of whom eighty-eight became pregnant (88/344, 25.5%). Half of them had a subsequent live birth (47/88, 53%) and the rest lost their pregnancy (41/88, 46%). The median CD138+ score was significantly lower in the live birth group (p<0.005) and women with a CD138+ score≥16/hpf had a higher risk of subsequent miscarriage (RR 10.0, 95%CI 2.78-36.02). CD138+ cells count showed a good prediction for subsequent pregnancy loss in high-risk women with an area under the curve of 0.75 (95%CI 0.59-0.82, p=0.01). A cut-off value of 4-6 cells/hpf offered the best predictive accuracy with higher scores predicting worse reproductive outcome. Our findings are limited by the small event rate and the sample size of our cohort.
Conclusion: Quantifying CD138+ cells by immunohistochemistry in women with a history of recurrent pregnancy loss is helpful to diagnose chronic endometritis and predict subsequent reproductive outcome.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RG Gynecology and obstetrics | |||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Cell & Developmental Biology Faculty of Medicine > Warwick Medical School > Biomedical Sciences Faculty of Science > Life Sciences (2010- ) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Miscarriage, Endometrium -- Diseases -- Diagnosis, Endometrium -- Diseases -- Research, Fetal death -- Risk factors | |||||||||
| Journal or Publication Title: | Journal of Obstetrics and Gynaecology Research | |||||||||
| Publisher: | Wiley-Blackwell Publishing Asia | |||||||||
| ISSN: | 1341-8076 | |||||||||
| Official Date: | 2021 | |||||||||
| Dates: |
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| DOI: | 10.1111/jog.14585 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | In Press | |||||||||
| Publisher Statement: | This is the peer reviewed version of the following article: Rimmer, M.P., Fishwick, K., Henderson, I., Chinn, D., Al Wattar, B.H. and Quenby, S. (2020), Quantifying CD138+ cells in the endometrium to assess chronic endometritis in women at risk of recurrent pregnancy loss: A prospective cohort study and rapid review. J. Obstet. Gynaecol. Res., which has been published in final form at http://dx.doi.org/10.1111/jog.14585. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| Copyright Holders: | © 2020 Japan Society of Obstetrics and Gynecology | |||||||||
| RIOXX Funder/Project Grant: |
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