Chronic endometritis is a persistent, low-intensity inflammation of endometrial mucosa, characterized by the infiltration of plasma cells into the endometrial stroma This immunological alteration is thought to be a consequence of a bacterial infection. For a long time, chronic endometritis was poorly investigated and rarely considered in clinical practice because it is either asymptomatic or presents with no specific symptoms. Its association with adverse effects on fertility and retrospectively reported effectiveness of antibiotic treatment were the main reasons for a growing interest in this endometrial pathology. Chronic endometritis is now a hot topic in recurrent pregnancy loss and recurrent implantation failure research. Nevertheless, there are still no recommendations to include chronic endometritis investigation in a clinical evaluation of infertile patients. The uncertain role of this condition is an effect of significant differences in study results presented by different research groups. One important reason for these inconsistent findings is a lack of standardised chronic endometritis diagnostic methods. We present a review of the literature, focusing on the currently available chronic endometritis diagnostic techniques. The review is subdivided into three parts concerning the diagnostic accuracy of three main diagnostic modalities. Histopathological examination of endometrial tissue, hysteroscopic evaluation of uterine cavity and identification of the bacterial factor. In conclusion, it is of great importance to establish a consensus on the diagnostic criteria for chronic endometritis. This is the only way to enhance international cooperation and create well-design multicenter studies to evidence the role of this endometrial pathology in infertility. Chronic endometritis is a persistent, low-intensity inflammation of endometrial mucosa, characterized by the infiltration of plasma cells into the endometrial stroma This immunological alteration is thought to be a consequence of a bacterial infection. For a long time, chronic endometritis was poorly investigated and rarely considered in clinical practice because it is either asymptomatic or presents with no specific symptoms. Its association with adverse effects on fertility and retrospectively reported effectiveness of antibiotic treatment were the main reasons for a growing interest in this endometrial pathology. Chronic endometritis is now a hot topic in recurrent pregnancy loss and recurrent implantation failure research. Nevertheless, there are still no recommendations to include chronic endometritis investigation in a clinical evaluation of infertile patients. The uncertain role of this condition is an effect of significant differences in study results presented by different research groups. One important reason for these inconsistent findings is a lack of standardised chronic endometritis diagnostic methods. We present a review of the literature, focusing on the currently available chronic endometritis diagnostic techniques. The review is subdivided into three parts concerning the diagnostic accuracy of three main diagnostic modalities. Histopathological examination of endometrial tissue, hysteroscopic evaluation of uterine cavity and identification of the bacterial factor. In conclusion, it is of great importance to establish a consensus on the diagnostic criteria for chronic endometritis. This is the only way to enhance international cooperation and create well-design multicenter studies to evidence the role of this endometrial pathology in infertility.

The objective of this study is to investigate the presence of bacteria in endometrial samples from patients with recurrent pregnancy loss (RPL) and explore potential correlations between bacterial presence, chronic endometritis, and previous pregnancy loss history. Endometrial samples from 90 RPL patients were analysed using RT-PCR to detect 10 specific bacterial species. A subgroup of 65 patients underwent additional microbial culture and immunohistochemistry for plasma cell identification. Correlations between bacterial presence, chronic endometritis, and the number of previous pregnancy losses were evaluated. We detected at least one out of 10 chosen bacteria DNA by RT-PCR in 24.4% (22/90) of endometrial samples. Patients with PCR-identified bacteria had a significantly higher number of previous pregnancy losses (median 3 vs 2, p = 0.01). No correlation was observed between bacterial presence and chronic endometritis diagnosis. A significant correlation was found between bacterial detection by PCR and microbial culture (p = 0.03), though culture methods detected fewer positive cases. In RPL patients, detecting DNA from at least one of 10 selected bacterial species by RT-PCR correlates with a higher number of previous pregnancy losses. However, this bacterial presence does not correlate with chronic endometritis diagnosis based on the CD138 immunohistochemistry-identified plasma cell count. These findings suggest a potential role of endometrial bacteria in RPL that may be independent of the classical inflammatory response associated with chronic endometritis.

Introduction. The majority of patients diagnosed with systemic connective tissue diseases are women of childbearing age. Aim. The analysis of obstetric results and exacerbation rates in the pregnancies involving systemic connective tissue diseases. Material and Methods. We retrospectively reviewed perinatal outcomes of fourteen women with systemic connective tissue diseases hospitalised in the Department of Reproduction in the period between September 2019 and July 2021. Results. Median duration of a pregnancy was 37 weeks. One pregnancy ended in a stillbirth in week 28. Of the 13 live births, preterm delivery occurred in 5 cases. Of the 13 live-birth neonates, preterm delivery occurred in five cases. The Caesarean section rate was 57.1% and vaginal delivery rate was 42.9%. The mean birth weight of the live neonates was 2787g (SD 892), and the median Apgar score in the 1st and the 3rd minute was 10. In total, all 4 patients with the active disease at the time of conception and 1 who did not decide to undergo the recommended mitral valve surgery prior to pregnancy experienced symptoms indicating a disease flare-up in the course of pregnancy. None of the patients who planned their pregnancy experienced an exacerbation of the disease. Conclusions. All patients diagnosed with systemic connective tissue diseases should receive multidisciplinary care prior to conception, during pregnancy and in the postpartum period. Furthermore, they should be monitored by a team of specialists, due to the risk of a disease exacerbation and high rates of maternal and foetal complications resulting from the underlying condition.

Pregnancy in a patient diagnosed with systemic connective tissue disorder is a challenge that requires a close co-operation between a rheumatologist and gynaecologist. Good control over the activity of the underlying condition and the choice of appropriate time for planning a pregnancy have direct effect on the pregnancy results in these patients. Applying gynaecological supervision adequate to the increased risk of complications is also very important. The aim of this study is to present the current knowledge on the care over pregnant patients with systemic connective tissue diseases and to draw attention to the importance of pregnancy planning in this group of patients. Pregnancy in a patient diagnosed with systemic connective tissue disorder is a challenge that requires a close co-operation between a rheumatologist and gynaecologist. Good control over the activity of the underlying condition and the choice of appropriate time for planning a pregnancy have direct effect on the pregnancy results in these patients. Applying gynaecological supervision adequate to the increased risk of complications is also very important. The aim of this study is to present the current knowledge on the care over pregnant patients with systemic connective tissue diseases and to draw attention to the importance of pregnancy planning in this group of patients.

Background: Endometriosis is a chronic inflammatory disease affecting approximately 10% of women of reproductive age and is commonly associated with pelvic pain and infertility. Increasing evidence indicates that lower urinary tract symptoms (LUTS) are more common in women with endometriosis, even in the absence of direct urinary tract involvement; however, the underlying mechanisms remain poorly understood. This study aimed to compare LUTS in women with surgically confirmed endometriosis and symptomatic women in whom endometriosis was surgically excluded, and to investigate their association with urethral ultrasonographic parameters and lesion localization. Methods: This prospective case–control study included 163 women: 81 with surgically confirmed endometriosis and 82 symptomatic controls in whom endometriosis was surgically excluded. Urinary symptoms were assessed using the validated Urogenital Distress Inventory Short Form (UDI-6). Urethral length and mobility were evaluated by transvaginal pelvic floor ultrasonography at rest, during pelvic floor muscle contraction, and during the Valsalva maneuver. Associations between urinary symptoms, ultrasonographic findings, lesion localization, and selected clinical variables were analyzed using appropriate non-parametric tests and multivariable linear regression. Results: Women with endometriosis demonstrated significantly higher total UDI-6 scores than symptomatic controls (p = 0.002), indicating a greater burden of lower urinary tract symptoms. Significant differences were observed only for pain/discomfort and post-void urine leakage, whereas the remaining UDI-6 domains did not differ between groups. Overall urethral ultrasonographic parameters were comparable between groups. However, among symptomatic women (UDI-6 ≥ 1), urethral mobility during the Valsalva maneuver was significantly lower in women with endometriosis than in controls (p = 0.041). Endometriosis localization was not associated with urinary symptom severity or urethral ultrasonographic findings. In multivariable analysis, previous cesarean section, but not endometriosis itself, was independently associated with higher UDI-6 scores. Conclusions: Women with surgically confirmed endometriosis experienced a greater burden of lower urinary tract symptoms than symptomatic women without endometriosis, particularly pain/discomfort and post-void urine leakage. These symptoms were not associated with lesion localization or major differences in urethral morphology, indicating that structural urethral abnormalities alone do not explain urinary symptom severity in this population. Routine assessment of urinary symptoms using validated questionnaires may facilitate comprehensive evaluation of women with endometriosis. Further prospective multicenter studies incorporating standardized pain assessment, urodynamic evaluation, and longitudinal follow-up are warranted to better elucidate the mechanisms underlying lower urinary tract symptoms in this population.