HISTOPATHOLOGICAL STUDY OF ENDOMETRIAL TISSUE IN RECURRENT MISCARRIAGES WITH BIOCHEMICAL AND PHYSIOLOGICAL CORRELATION
Main Article Content
Keywords
Recurrent miscarriage; Endometrial histopathology; Luteal phase defect; Progesterone; Thyroid dysfunction; Chronic endometritis; Endometrial receptivity.
Abstract
Background
Recurrent miscarriage is a significant reproductive health problem, affecting 1–2% of women in the reproductive age group. It is defined as two or more consecutive spontaneous pregnancy losses before twenty weeks of gestation. Despite multiple known causes, many cases remain unexplained. Endometrial receptivity, hormonal imbalance, and subtle inflammatory changes are now recognized as important contributing factors. Evaluating endometrial morphology along with biochemical and physiological parameters can help identify correctable causes of recurrent pregnancy loss.
Methodology
This descriptive cross-sectional study was conducted in the Department of Pathology, Jinnah Medical College and its affiliated hospital from January 2024 to January 2025. A total of 68 women aged 20–40 years with a history of two or more consecutive miscarriages were included. Detailed clinical data were collected, and blood samples were taken during the mid-luteal phase to assess serum progesterone, thyroid profile, and other reproductive hormones using ELISA. Endometrial biopsies were obtained in the late secretory phase and evaluated histologically following Noyes’ criteria. Statistical analysis was done using SPSS version 25, with a p-value < 0.05 considered significant.
Results
The mean age of participants was 29.6 ± 4.8 years. Low serum progesterone levels were observed in 39.7% of women, showing a significant correlation with out-of-phase endometrium (p = 0.003). Thyroid dysfunction was identified in 13.2% of participants and was significantly related to endometrial phase disturbance (p = 0.04). Histopathological findings revealed out-of-phase endometrium in 30.9%, luteal phase defect in 26.5%, and chronic endometritis in 20.6% of cases. Vascular congestion and stromal edema were frequent but statistically non-significant.
Conclusion
The study highlights that hormonal deficiency and endometrial inflammation are major contributing factors to recurrent miscarriage. Low serum progesterone and thyroid dysfunction are significantly associated with delayed endometrial maturation and histological abnormalities. Combined biochemical and histopathological evaluation of the endometrium plays an essential role in identifying underlying causes and guiding targeted management for improved pregnancy outcomes.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Samina Firdous
Assistant Professor, Department of Obstetrics and Gynaecology, Pak International Medical College, Peshawar, Pakistan
Amena Arif
Assistant Professor, Department of Biochemistry, Federal Medical College, Islamabad, Pakistan
Shahid Hasnain Siddiqui
Assistant Professor Histopathology, Department of Pathology, Jinnah Medical College,
Peshawar, Pakistan
Naila Ismail
Professor, Department of Pathology, Kabir Medical College, Peshawar, Pakistan
Anwar Shahzad
Associate Professor, Department of Community Medicine, Abbottabad International Medical Institute, Abbottabad, Pakistan
Tania Khattak
Assistant Professor, Department of Pathology, Nowshera Medical College/Qazi Hussain Ahmed Medical Complex, Nowshera, Pakistan