Objective To determine the implications of an incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile population. Methods Retrospective cohort study at a tertiary care, university‐based facility. All patients with intrauterine pregnancy on initial obstetric ultrasound presenting to an infertility clinic between January 2015 and March 2018 (n = 1210), regardless of treatment cycle, were included. Nonviable pregnancies were excluded. The main outcome measured was association between subchorionic hematoma and first trimester miscarriage. Results The prevalence of subchorionic hematoma was 12.5% (n = 151) and did not differ by type of fertility treatment. There was no association between subchorionic hematoma and first trimester miscarriage; however, among patients with subchorionic hematoma, those who reported both bleeding and cramping had an increased probability of miscarriage compared to those without symptoms (0.62 vs. 0.12, P <0.001). The live birth rate in this sample was 81.3% and there were no statistically significant differences in pregnancy outcomes between those with and without subchorionic hematoma. Conclusion Among an infertile population, there was no increased risk of miscarriage when subchorionic hematoma was seen on early ultrasound; however, when patients noted both vaginal bleeding and cramping, their probability of miscarriage was significantly increased.

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OBJECTIVE: Chronic endometritis (CE) has been associated with recurrent pregnancy loss (RPL) and recurrent implantation failure. Incidence rates vary due to significant heterogeneity in biopsy timing and diagnostic criteria. Our group previously demonstrated that plasma cells are found in 59% of endometrial biopsies (EMBs) in the follicular phase compared to 18% in the luteal phase, which led us to question whether menstruation or hormonal changes in the follicular phase impact the diagnosis of CE. The purpose of this study was to assess the incidence and density of endometrial plasma cells in the early versus late follicular phase.DESIGN: This is a retrospective cohort study of patients undergoing EMB in the follicular phase at a single academic center.MATERIALS AND METHODS: EMBs performed between 2018 and 2020 were included. The early follicular phase was defined as the end of menses through day 8 of the menstrual cycle. The late follicular phase was defined as 9-14 days after menses. Patients with a prior CE diagnosis or abnormal uterine pathology were excluded. EMBs were assessed by gynecologic pathologists via H&E stain and CD138 immunohistochemistry. Plasma cell density was reported as rare (1-2 per slide), scattered (R 3 per slide), or clusters. Continuous variables were compared using t-tests, and categorical variables were compared with chi-square tests.RESULTS: Plasma cells were found in 74% of EMBs performed in the early follicular phase compared to 45% in the late follicular phase. Although the study was not powered to detect differences in plasma cell density, plasma cells were most commonly noted to be scattered (39%) in the early follicular and rare (18%) in the late follicular phase. See Table 1 for complete results.CONCLUSIONS: Our data demonstrate that plasma cells are more likely to be detected at higher densities in EMBs performed during the early compared to the late follicular phase. These findings may represent the influence of estrogen levels or menstruation on the endometrium. Further studies with larger cohorts are needed to establish the optimal timing of EMB and determine the clinical significance of low-density endometrial plasma cells.

OBJECTIVE: Unexplained recurrent pregnancy loss (uRPL) includes non-visualized pregnancy loss (NVPL, i.e. preclinical), visualized pregnancy loss (VPL, i.e. clinical), and Mixed (combination of VPL and NVPL) types of pregnancy losses. Our objective was to evaluate the association between the types of prior pregnancy losses and the outcome of the subsequent pregnancy in a cohort of uRPL women.DESIGN: A retrospective cohort study approved by ethics board (Approval number: H13-03306).MATERIALS AND METHODS: Women with uRPL who were referred to the RPL centre at British Columbia Women's Hospital (BCWH), between from January 1, 2011 to August 31, 2017 (n¼806) were included. Their clinical evaluations were completed according to the American Society of Reproductive Medicine (ASRM) guidelines. Data were collected using Research Electronic Data Capture (REDCap) data management platform. We compared women who had only non-visualized pregnancy losses (NVPL) with women who had only visualized pregnancy losses (VPL) and those with both types of uRPL with respect to demographic and clinical characteristics. We also compared pregnancy outcomes (successful pregnancy R10 weeks gestation vs. miscarriage at < 10 weeks gestation) among women with NVPL vs VPL groups. Logistic regression was used to adjust for potential confounders.RESULTS: There were 142 (18%) women with only NVPL, while 152 (19%) women had only VPL. The remaining 512 (63%) women had a mixture of both. In this cohort of 806 women, 679 had a subsequent pregnancy within 12 months, among these, 397 (58.4%) pregnancy reached R10 weeks' gestation, and 282 (41.5%) of pregnancies were miscarried (<10 week's gestation). Successful pregnancy reaching R10 weeks occurred in 45.4% (69/152) women with VPL, in 35.2% (50/142) women with NVPL, and in 54.3% (278/512) of women with both types (mixed group).Compared to women with VPL, women with NVPL were more likely to have prior primary pregnancy losses (AOR ¼ 2.26, 95% CI ¼ 1.32 -3.86), and prior history of therapeutic abortions (AOR ¼4.26 and 95% CI ¼ 1.65 -11.02). Among those who became pregnant, women with VPL were more likely to remain pregnant at or beyond 10 weeks' gestation (AOR ¼ 1.94, 95% CI ¼ 1.03 -3.66).CONCLUSIONS: Our study suggests that exclusive NVPLs are prevalent in women with uRPL. Women who had only NVPL were more likely to experience miscarriage at < 10 weeks' gestation compared with women with VPL in their subsequent pregnancy.

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