Uterine hemodynamics in the first trimester after treatment of chronic endometritis: comparison between ongoing pregnancy and early pregnancy loss
Ozerskaya I.A., Porkhovaty S.Ya., Kazaryan G.G., Ozhogina E.V.
Objective: To identify the characteristics of uterine hemodynamics in patients after treatment of chronic endometritis at 5–7 and 8–10 weeks of gestation, and to assess association between the changes in uterine hemodynamics and first trimester pregnancy status (ongoing pregnancy/pregnancy loss).
Materials and methods: The retrospective analysis included 112 pregnant women with a history of diagnosed chronic endometritis (CE). Of them 62 women previously underwent comprehensive treatment at 5–7 weeks of gestation (46 had ongoing pregnancy, 18 experienced pregnancy loss), and 48 women underwent treatment at 8–10 weeks of gestation (42 had ongoing pregnancy, 6 experienced pregnancy loss). Uterine artery Doppler ultrasound evaluation of Vmax, Vmin, Vmean, PI, RI was performed, and the arterial perfusion index (API) was calculated at the given gestational age based on pregnancy status.
Results: After treatment of CE, the most informative parameters were API and Vmean at 5–7 weeks of gestation, whereas at 8–10 weeks the differences in these parameters were predominantly associated with uterine vascular resistance indices (PI, RI) and Vmean.
Conclusion: After treatment of CE, the parameters of uterine hemodynamics in early pregnancy varied in relation to gestational age and pregnancy status in the first trimester. Comprehensive assessment of uterine artery blood flow parameters can improve the clinical benefits of uterine artery Doppler ultrasound in management of early pregnancy in women with a history of chronic endometritis.
Authors' contributions: Ozerskaya I.A. – the study concept and design, article editing; Pohkhovaty S.Ya. – material collection and processing; Kazaryan G.G., Ozhogina E.V. – article writing; Ozhogina E.V. – statistical data processing.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: The study was approved by the local Ethics Committee of the Faculty of Continuous Medical Education, Patrice Lumumba Peoples’ Friendship University of Russia.
Patient Consent for Publication: The patients have signed informed consent for participation in the study and publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Ozerskaya I.A., Porkhovaty S.Ya., Kazaryan G.G., Ozhogina E.V. Uterine hemodynamics in the first trimester after treatment of chronic endometritis: comparison between ongoing pregnancy and early pregnancy loss.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (2): 78-85 (in Russian)
https://dx.doi.org/10.18565/aig.2026.01
Keywords
ultrasound diagnostics
pregnancy
chronic endometritis
uterine blood flow
Doppler ultrasound
References
- Александрова Т.Н., Юрьев С.Ю. Хронический эндометрит как звено репродуктивных потерь: новые аспекты патогенеза (обзор литературы). Мать и дитя в Кузбассе. 2020; 4(83): 70-4. [Aleksandrova T.N., Yuriev S.Yu. Chronic endometritis as a part of reproductive losses: new aspects of pathogenesis (review of literature). Mother and Child in Kuzbass. 2020; 4(83): 70-4 (in Russian)]. https://dx.doi.org/10.24411/2686-7338 - 2020-10051
- HogenEsch E., Hojjati R., Komorowski A., Maniar K., Pavone M.E., Bakkensen J. et al. Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center. J. Assist. Reprod. Genet. 2023; 40(10): 2463-71. https://dx.doi.org/10.1007/s10815-023-02902-z
- Liu J., Liu Z.A., Liu Y., Cheng L., Yan L. Impact of antibiotic treatment for chronic endometritis on pregnancy outcomes in women with reproductive failures (RIF and RPL): a systematic review and meta-analysis. Front. Med. (Lausanne). 2022; 9: 980511. https://dx.doi.org/10.3389/fmed.2022.980511
- Дубровина С.О., Божинская Д.М., Гимбут В.С., Богунова Д.Ю., Циркунова Н.С., Циркунова К.Г. Хронический эндометрит. Акушерство и гинекология. 2024; 6: 147-52. [Dubrovina S.O., Bozhinskaya D.M., Gimbut V.S., Bogunova D.Yu., Tsirkunova N.S., Tsirkunova K.G. Chronic endometritis. Obstetrics and Gynecology. 2024; (6): 147-52 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.137
- Толибова Г.Х., Траль Т.Г., Коган И.Ю., Олина А.А. Эндометрий. Атлас. М.: StatusPraesens; 2022. 184 с. [Tolibova G.Kh., Tral T.G., Kogan I.Yu., Olina A.A. Endometrium. Atlas. Moscow: StatusPraesens; 2022. 184 p. (in Russian)].
- Yan X., Jiao J., Wang X. The pathogenesis, diagnosis, and treatment of chronic endometritis: a comprehensive review. Front. Endocrinol. 2025; 16: 1603570. https://dx.doi.org/10.3389/fendo.2025.1603570
- Kuroda K., Horikawa T., Moriyama A., Nakao K., Juen H., Takamizawa S. et al. Impact of chronic endometritis on endometrial receptivity analysis results and pregnancy outcomes. Immun. Inflamm. Dis. 2020; 8(4): 650-8. https://dx.doi.org/10.1002/iid3.354
- Duan H., Li X., Hao Y., Shi J., Cai H. Risk of spontaneous abortion after antibiotic therapy for chronic endometritis before in vitro fertilization and intracytoplasmic sperm injection stimulation. Fertil. Steril. 2022; 118(2): 337-46. https://dx.doi.org/10.1016/j.fertnstert.2022.04.026
- Sotiriadis A., Hernandez-Andrade E., da Silva Costa F., Ghi T., Glanc P., Khalil A. et al. ISUOG practice guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet. Gynecol. 2019; 53(1): 7-22. https://dx.doi.org/10.1002/uog.20105
- Oancea M., Grigore M., Ciortea R., Diculescu D., Bodean D., Bucuri C. et al. Uterine artery doppler ultrasonography for first trimester prediction of preeclampsia in individuals at risk from low-resource settings. Medicina (Kaunas). 2020; 56(9): 428. https://dx.doi.org/10.3390/medicina56090428
- Leible S., Canals A., Sepulveda W. Physiological asymmetry in uterine artery blood flow during the first trimester of pregnancy: new insights from a quantitative assessment using Pulsed-wave color Doppler and M-mode color power angio imaging. Placenta. 2022; 121: 109-15. https://dx.doi.org/10.1016/j.placenta.2022.03.006
- Rigano S., Ferrazzi E., Boito S., Pennati G., Padoan A., Galan H. Blood flow volume of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid-dynamic modeling. Placenta. 2010; 31(1): 37-43. https://dx.doi.org/10.1016/j.placenta.2009.10.010
- McKelvey A., Pateman K., Balchin I., Peebles D.M., Rodeck C.H., David A.L. Total uterine artery blood volume flow rate in nulliparous women is associated with birth weight and gestational age at delivery. Ultrasound Obstet. Gynecol. 2017; 49(1): 54-60. https://dx.doi.org/10.1002/uog.15917
- Mäkikallio K., Tekay A., Jouppila P. Uteroplacental hemodynamics during early human pregnancy: a longitudinal study. Gynecol. Obstet. Invest. 2004; 58(1): 49-54. https://dx.doi.org/10.1159/000077914
- Likhachov V., Taranovska О. Changes in the intensity of uterine circulation in pregnant women with a history of chronic endometritis. Neonatology, surgery and perinatal medicine. 2023; 13(2(48): 78-84. https://dx.doi.org/10.24061/2413-4260.XIII.2.48.2023.11
- Кохно Н.И., Самойлова Т.Е., Докудаева Ш.А. Прегравидарные прогностические критерии децидуита. Гинекология. 2019; 21(2): 58-65. [Kokhno N.I., Samoylova T.E., Dokudaeva Sh.A. Pregravid prognostic criteria for deciduitis. Gynecology. 2019; 21(2): 58-65 (in Russian)]. https://dx.doi.org/10.26442/20795696.2019.2.190221
- Bhide A., Acharya G., Baschat A., Bilardo C.M., Brezinka C., Cafici D. et al. ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics. Ultrasound Obstet. Gynecol. 2021; 58(2): 331-9. https://dx.doi.org/10.1002/uog.23698
- Salvesen K., Abramowicz J., Ter Haar G., Miloro P., Sinkovskaya E., Dall'Asta A. et al. ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated). Ultrasound Obstet. Gynecol. 2021; 57(6): 1020. https://dx.doi.org/10.1002/uog.23610
- Velauthar L., Plana M.N., Kalidindi M., Zamora J., Thilaganathan B., Illanes S.E. et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet. Gynecol. 2014; 43(5): 500-7. https://dx.doi.org/10.1002/uog.13275
- Лазарева Г.А., Чебышева Е.Л. Прогнозирование перинатального исхода при преэклампсии на основании доплерометрических показателей. Доктор.Ру. 2022; 21(5): 13-7. [Lazareva G.A., Chebysheva E.L. Prediction of perinatal outcome in preeclampsia based on Doppler parameters. Doctor.Ru. 2022; 21(5): 13-7 (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2022-21-5-13-17
- Доброхотова Ю.Э., Кузнецов П.А., Джохадзе Л.С. Привычное невынашивание. Актуальное сегодня (Протокол ESHRE 2023 г., Национальные клинические рекомендации «Привычный выкидыш» 2021 г., материалы Всемирного конгресса ESHRE 2023 г.). РМЖ. Мать и дитя. 2023; 6(3): 219-25. [Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S. Habitual miscarriage. Relevant today (ESHRE Protocol 2023, National Clinical Guidelines "Habitual Miscarriage" 2021, Proceedings of the ESHRE World Congress 2023). RMJ. Mother and Child. 2023; 6(3): 219-25 (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2023-6-3-1
- Kimura F., Takebayashi A., Ishida M., Nakamura A., Kitazawa J., Morimune A. et al. Review: chronic endometritis and its effect on reproduction. J. Obstet. Gynaecol. Res. 2019; 45(5): 951-60. https://dx.doi.org/10.1111/jog.13937
- Ticconi C., Inversetti A., Marraffa S., Campagnolo L., Arthur J., Zambella E. et al. Chronic endometritis and recurrent reproductive failure: a systematic review and meta-analysis. Front. Immunol. 2024; 15: 1427454. https://dx.doi.org/10.3389/fimmu.2024.1427454
- Aygün E.G., Kahraman E. First-trimester uterine artery Doppler indices and pregnancy outcomes in naturally conceived and frozen-thawed embryo transfer cycles. Diagnostics (Basel). 2025; 15(17): 2223. https://dx.doi.org/10.3390/diagnostics15172223
- Pellizzari P., Pozzan C., Marchiori S., Zen T, Gangemi M. Assessment of uterine artery blood flow in normal first-trimester pregnancies and in those complicated by uterine bleeding. Ultrasound Obstet. Gynecol. 2002; 19(4): 366-70. https://dx.doi.org/10.1046/j.1469-0705.2002.00667.x
- Leible S., Cumsille F., Walton R., Muñoz H., Jankelevich J., Sepulveda W. Discordant uterine artery velocity waveforms as a predictor of subsequent miscarriage in early viable pregnancies. AJOG. 1998; 179(6): 1587-93. https://dx.doi.org/10.1016/S0002-9378(98)70030-4
- Cavoretto P.I., Salmeri N., Candiani M., Farina A. Reference ranges of uterine artery pulsatility index from first to third trimester based on serial Doppler measurements: longitudinal cohort study. Ultrasound Obstet. Gynecol. 2023; 61(4): 474-80. https://dx.doi.org/10.1002/uog.26092
- Guedes-Martins L., Saraiva J.P., Gaio A.R., Reynolds A., Macedo F., Almeida H. Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study. BMC Pregnancy Childbirth. 2015; 15: 28. https://dx.doi.org/10.1186/s12884-015-0464-9
- Zhong Y., Wang N., Lu S., Lu Y., Pan X., Zhou Y. Doppler evaluation of uterine blood flow in patients with unexplained recurrent pregnancy loss. Int. J. Womens Health. 2024; 16: 1803-14. https://dx.doi.org/10.2147/IJWH.S477828
- Bachnas M.A., Budihastuti U.R., Melinawati E., Anggraini N.W.P., Ridwan R., Astetri L. et al. First-trimester Doppler ultrasound for predicting successful management of pregnancy with recurrent pregnancy losses due to antiphospholipid syndrome and thrombophilia: a cohort study. J. Hum. Reprod. Sci. 2024; 17(4): 261-8. https://dx.doi.org/10.4103/jhrs.jhrs_137_24
- Prins L.I., Smith E., Naaktgeboren Ch.M., Khan M.G., Bilardo C.M., Griffioen W. et al. Inter- and intra-observer reliability in first-trimester uterine artery Doppler measurements. Eur. J. Obstet. Gynecol. Reprod. Biol. 2025; 311: 114058. https://dx.doi.org/10.1016/j.ejogrb.2025.114058
- Benjamini Y., Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological). 1995; 57(1): 289-300. https://dx.doi.org/10.1111/j.2517-6161.1995.tb02031.x
- Сухих Г.Т., Шуршалина А.В. Хронический эндометрит: руководство. М.: ГЭОТАР-Медиа; 2013. 64 с. [Sukhikh G.T., Shurshalina A.V. Chronic endometritis: a guide. Moscow: GEOTAR-Media; 2013. 64 p. (in Russian)].
- Суханов А.А., Дикке Г.Б., Кукарская И.И. Эпидемиология женского бесплодия и опыт восстановления репродуктивной функции у пациенток с хроническим эндометритом в Тюменском регионе. Проблемы репродукции. 2023; 29(3): 98-107. [Sukhanov A.A., Dikke G.B., Kukarskaya I.I. Epidemiology of female infertility and the experience of recovery of reproductive function in patients with chronic endometritis in the tyumen region. Russian Journal of Human Reproduction. 2023; 29(3): 98-107 (in Russian)]. https://dx.doi.org/10.17116/repro20232903198
- Гомболевская Н.А., Марченко Л.А., Муравьева В.В. Современные методы лечения пациенток с хроническим эндометритом. Акушерство и гинекология. 2015; 12: 39-45. [Gombolevskaya N.A., Marchenko L.A., Muravyova V.V. Modern methods of treatment of patients with chronic endometritis. Obstetrics and Gynecology. 2015; (12): 39-45 (in Russian)].
- Chen X., Chen M., Liu M., Qi L., Liu Z., Chen C. et al. Intrauterine infusion of autologous platelet-rich plasma modulates endometrial immune status and improves pregnancy outcomes in patients with persistent chronic endometritis. Front. Immunol. 2025; 16: 1528522. https://dx.doi.org/10.3389/fimmu.2025.1528522
Received 12.01.2026
Accepted 29.01.2026
About the Authors
Irina A. Ozerskaya, Dr. Med. Sci., Professor, Professor at the Department of Ultrasound Diagnostics of the Faculty of Continuing Medical Education of the Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), 117198, Russia, Moscow, Miklukho-Maklay str., 6, +7(926)606-09-05,ozerskaya_usd@mail.ru, https://orcid.org/0000-0001-8929-6001
Sergey Ya. Porkhovaty, PhD, Ultrasound diagnostics doctor, LLC “Asklepion”, 125222, Russia, Moscow, Dubravnaya str., 41 bldg. 2, https://orcid.org/0009-0002-7263-1568
Gayane G. Kazaryan, PhD, Head of the Ultrasound Department, LLC “Medskan”, 119421, Russia, Moscow, Obrucheva str., 21A, https://orcid.org/0000-0002-1198-8187
Ekaterina V. Ozhogina, PhD, Leading Reproductive Specialist, Nova Clinic Center for Reproduction and Genetics, 119415, Russia, Moscow, Lobachevsky str., 20,
https://orcid.org/0009-0007-5205-2901
Corresponding author: Irina A. Ozerskaya, ozerskaya_usd@mail.ru
Similar Articles
