Chronic endometritis: is it the last limit of ultra sounding in the exploration of the endometer? Ultrasound versus hysteroscopy: 3-year study.

Z.Farah-I.Bounab-S.Boubezoul-S.Ramda-R.Khodja Bologhine hospital – gynecology department – Algiers –Algeria

RESULTS: Mean age 34 ± 2.4 years, patients are referred for these indications : implantation failures in 30.4% ; for polyp in 16.6% and for systematic hysteroscopy pre-AMP in 53.2% of cases. Ultrasonography revealed polyps in 19% of cases, adenomyosis 8%, endometrial hypertrophy 4% , and without abnormalities in 69%. The hysteroscopic aspects found were as follows: 24% endo-cavity polyp, 5.5% endometrial hypertrophy (fig 5),4.5% adenomyosis, 8.5% endometrial atrophy (fig6), endometritis appearance 15% : micropolyps(fig 1-2) - haemorrhage (fig 3-4) endometrium without abnormalities 42.5% The anapath study of the endometrial biopsy found 2 cases of tuberculous endometritis (3.8%) and 9 cases (17.3%) of infectious endometrit is (Chlamydia-Ureaplasma), therefore 11 cases of endometritis ( 21.1%)

INTRODUCTION: The exploration of the endometrium is a decisive step in the management of infertility, especially in PMA. Failures of implantation remain unexplained in a number of cases. The quality of the endometrium is partly responsible for these failures, especially in cases of chronic endometritis. The diagnosis of the great majority of intracavitary lesions is possible with ultrasoud,but it remains limited in the case of endometriosis as bacteriological or histological evidence is necessary. We report the experience of our departement over 3years. MATERIAL AND METHOD :Transversal study over a period of 3 years in 52 cases of infertile patients in AMP ,we evaluated the hysteroscopic indications and then we compared the echographic diagnosis, the hysteroscopic aspect to the results of the anatomopathological diagnosis.

Fig1-2:hysteroscopicappearanceofmicropolyps

Fig3-4:hysteroscopicappearanceofhemorragea

Fig5:endometrialhypertrophy Fig6:endometrialatrophy

DISCUSSION T h e c o n c o r d a n c e b e t w e e n t h e echographic and hysteroscopic aspect is found in cases of polyps, hypertrophy of the endometr ium, but in case of endometritis the ultrasound gives no particular information. hysteroscopy found an appearance of micropolyps and localized hemorrhage in 15% of cases, and anapath confirms this diagnosis in 11 cases, including uterine tuberculosis : the hysteroscopic aspect was probably atrophy of the endometrium.

Conclusion: In our study Hysteroscopy has a superiority in the diagnosis of chronic endometritis compared to ultrasound. Even if the endometrial aspect of the endomet r ium seems norma l , the h i s t o l o g i c a l v e r i f i c a t i o n o f t h e endometrium seems important especially in infertility and pre-PMA.