Interactive Session - Recurrent Pregnancy Loss: One Should Evaluate for Chronic Endometritis Debate

Date:October 22, 2014

Time:1:15 pm - 2:15 pm

Location:HCC318 - Hawaii Convention Center

Presenters

Danny J. Schust, M.D. (Chair), University of Missouri

Mary D. Stephenson, M.D., University of Illinois at Chicago

Steven L. Young, M.D., University of North Carolina School of Medicine

(Debate)

Needs Assessment and Description
A timed, luteal-phase endometrial biopsy was part of the standard evaluation for recurrent pregnancy loss for many years. Data demonstrating its poor predictive value for histological evaluation of the “luteal-phase defect” caused it to be dropped from this workup by most practitioners. New data have suggested that this procedure should again be employed in evaluations for recurrent pregnancy loss— however, now for the diagnosis of chronic endometritis. This debate will address the utility of the endometrial biopsy for the diagnosis of chronic endometritis in this diagnostically and therapeutically difficult patient population. The session is designed for clinicians involved in the care of infertile women and those with recurrent pregnancy loss. 

Learning Objectives
At the conclusion of this session, participants should be able to: 

  1. Determine whether the diagnosis of chronic endometritis has prognostic or diagnostic value in a patient with a history of recurrent pregnancy loss. 
  2. Discuss the utility of adding this test to the recurrent pregnancy loss workup in clinical practice. 
ACGME Competency
Patient Care 

TEST QUESTION
A 33-year-old, gravida 3, para 0030 female has had a history of 2 miscarriages and 1 fetal demise of 10 weeks’ size. Karyotypes on the last 2 pregnancy losses were 46,XY and 46,XX (maternal contamination excluded using single-nucleotide polymorphism [SNP] analysis). After participating in this session, in my practice I will:
a. Perform an endometrial biopsy as part of her diagnostic workup.
b. Recommend maternal karyotyping only.
c. Recommend paternal karyotyping only.
d. Evaluate the uterine cavity.
e. Not applicable to my area of practice

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