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CLINICAL, MORPHOLOGICAL AND MOLECULAR FEATURES OF CHRONIC
ENDOMETRITIS IN WOMEN WITH INFERTILITY
Kurbaniyazova Aziza Zafarjonovna
Bukhara State Medical University Department of Obstetrics and Gynecology N 2
https://doi.org/10.5281/zenodo.13913773
Research materials:
Many scientists agree on the feasibility of complex two-stage therapy
for CE [10, 16, 23, 25, 26]. The first step is to eliminate the infectious agent from the endometrium,
which is achieved by prescribing broad-spectrum antibiotics aimed mainly against UPM. In a
randomized placebo-controlled study, W. Andrews et al. [27] analyzed the dynamic changes in the
composition of microorganisms in the endometrium in patients who received and did not receive
AB treatment. The authors confirmed that the introduction of AB drugs significantly ensures the
elimination of pathogens from the endometrium: UPM before treatment in 86% of cases, then in
37% (p<0.05), without treatment these indicators were 91 and 60. % (p> 0.05) respectively. E.
Cicinelli and others. [28] after performing hysteroscopy and prescribing AB therapy to patients
with histologically confirmed CE, 71% of women showed complete normalization of
hysteroscopic and morphological images of the endometrium and UPM was eliminated from the
uterine cavity. managed to do q. 78.4% of patients in this group subsequently became pregnant.
The authors concluded that antibiotic treatment for CE has beneficial effects in eliminating
microorganisms from the endometrium and improving reproductive outcomes.
Object of the study:
Absence of microorganisms or detection of lactobacilli /
bifidobacteria in endometrial biopsy during cultural examination in women with a diagnosis of CE
morphologically confirmed by local [6, 10, 16, 23, 25, 26, 29] and some foreign scientists. [30] is
evaluated as the imperfection of the performed diagnostic measures. In such cases, as well as when
it is impossible to carry out microbiological diagnostics, it is recommended to prescribe empiric
AB therapy, taking into account the wide range of aerobic-anaerobic origin. AB treatment aimed
at eliminating the infection helps to eliminate the clinical manifestations of the disease by
normalizing the structural damage of the endometrium. AV Shurshalina, L. Eckert and others. [16,
18] showed that empirically prescribed antimicrobial therapy leads to a significant decrease in the
frequency of uterine bleeding, restoration of the morphological structure of the endometrium in
57.1 and 89.5% of cases, respectively, and a decrease in the level is also observed. The main
symptoms of inflammation.
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Research results:
in 2015, E. Cicinelli et al. [31] showed that CE treatment efficiency
reached 83.3% in terms of normalizing the morphological picture of the endometrium when
antibiotics were prescribed, taking into account the determined spectrum of microorganisms.
According to the 2010 CDC recommendations [32], prescribing empiric therapy (ciprofloxacin in
combination with doxycycline and metronidazole) to patients with conditionally sterile crops
restored the morphological picture of the endometrium in only 46.2% of cases, although the
patients were in this condition. this group was treated with three consecutive empirically
determined treatment courses with AB drug changes. This study convincingly proves the need to
find new diagnostic methods to more accurately assess the true microbial landscape of the uterine
cavity.
In the office, the infectious agent plays a leading role in provoking the inflammatory
process in the endometrium. In some cases, removal of the pathogen from the uterine cavity can
occur without AB therapy [24, 27, 33]. In this case, microorganisms can leave secondary damage
to the structure of the mucous membrane of the uterine cavity.
Conclusion
: Modern literature discusses the role of AB drugs in changing the vaginal
microsenosis with the formation of pathological associations of microorganisms, as well as in the
accumulation of endotoxins and other microbial metabolites that contribute to the development of
the inflammatory reaction of the macroorganism [33-36]. ]. In 2006 [27], a clinical randomized
placebo-controlled study was conducted including women with recurrent miscarriage and
morphologically confirmed cholecystectomy. The study did not reveal any difference in the
incidence of subsequent pregnancies in the groups of patients who received AB therapy (n = 52)
and placebo (n = 56) - 53 and 59%, respectively. However, there was a tendency for the placebo
group to prolong pregnancy by an average of 2.4 weeks and increase the weight of the newborns
by an average of 418 g. The authors suggested the possibility of the development of
microecological disorders in the vagina in response to AB therapy, which increases the risk of
infection. Thus, prophylactic empiric prescription of antimicrobials with suspected CE is not
always justified [27, 37, 38].
Recognizing the importance of AB therapy as a leading therapeutic approach to eliminate
microbial agents from the site of inflammation, some authors believe that a similar result can be
achieved using surgical approaches. In a clinical randomized placebo-controlled study, a number
of scientists [27] examined 124 women with suspected CE who underwent hysteroscopy and
diagnostic endometrial curettage to confirm the diagnosis. There were 2 groups: Group I (n = 59)
received AB treatment, Group II (n = 65) received placebo. The effectiveness of the therapy was
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evaluated based on the dynamics of plasma cells in the endometrium. The analysis of the results
showed that AB therapy did not always help the treatment of CE with the normalization of the
morphological appearance of the endometrium: in 22% of patients, plasma cells continued to be
detected after treatment compared to 31% before prescribing antibiotics. (p>0.05). However, in
the placebo group, the detection of plasma cells in the endometrium before and after treatment was
47 and 29%, respectively (p>0.05). Thus, AB therapy does not always normalize the
morphological picture of the mucous membrane of the uterine cavity; however, only the use of
hysteroscopy and diagnostic endometrial curettage has a positive effect on the loss of plasma cells.
The presented results show that the mechanisms of spontaneous restoration of the morphological
structure of the endometrium without the use of antibiotics remain unclear.
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