HISTOPATHOLOGICAL STUDY OF ENDOMETRIAL TISSUE IN RECURRENT MISCARRIAGES WITH BIOCHEMICAL AND PHYSIOLOGICAL CORRELATION

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.