OP11.02: The sonographic evaluation of subendometrial wave‐like activity in patients with endometritis

The uterus shows wavelike activity (WA) throughout the menstrual cycle. Transvaginal sonography (TVS) has made it possible to study the movements of the subendometrial layers of the myometrium. Several WA patterns have been described. They are governed by steroid hormones but may also be influenced by other conditions. Inadequate uterine contractility may lead to ectopic pregnancies, miscarriages, retrograde bleeding with dysmenorrhea and endometriosis. Subendometrial WA has never been considered in patients with endometritis. Subendometrial WA was studied by TVS, throughout 30 ovulatory cycles in 30 nulliparous patients with endometritis. Analysis was focused on the presence of WA, considering the wave types and their frequency in periovulatory and midluteal phase. A 3-min transvaginal sagittal scan of the uterus was recorded. The direction and the frequency of WA were analyzed off-line on accelerated image sequences. Data were compared with a control group of 30 cycling, age-matched, healthy volunteers observed at the same representative stages. During the periovulatory phase, in the endometritis group the WA pattern showed antegrade, retrograde, opposing, not propagated/absent motility. In the control group, only a retrograde WA was distinguished. In this phase the frequency of contractions was higher in the control group (2.8 vs. 2.1 contractions/minute). In both the groups, during the midluteal phase, most of the waves disappeared and their frequency was similar. In this phase, the WA pattern was not propagated/absent in 56.7% and opposing in 43.3% of the patients with endometritis. It was not propagated/absent in 93.3% of the healthy volunteers. In the periovulatory phase, patients with endometritis did not show a normal retrograde WA and their frequency was lower. Retrograde motility may allow the transport of sperm towards the distal end of the Fallopian tubes where fertilization normally takes place.