EP21.05: Endometrial junctional zone disruption in pregnancy loss: case series from a tertiary recurrent miscarriage clinic

The aim of this study was to quantify the disruption of the junctional endometrial junctional zone in cases of recurrent miscarriage by developing a novel scoring system based on the assessment of the endometrium and the myometrium using 3D transvaginal ultrasound scan. This is a retrospective cohort study including patients that had a transvaginal pelvic 3D ultrasound after attending a tertiary recurrent miscarriage clinic between November 2022 and March 2024, Inclusion criteria involved women with at least 1 early pregnancy loss. Exclusion criteria involved ultrasound findings indicative of Mullerian abnormalities such as a uterine septum. Junctional zone disruption was quantified by 2 blinded independent assessors using a new scoring system, whereby the disruption was classified as non-existent, focal or generalised. Statistical analysis was performed using the non-parametric Kruskal-Wallis test with Dunn's correction for multiple comparisons. Interrater reliability was assessed by calculating the weighted Cohen's kappa. 84 patients were included in the study. 4 were excluded due to the identification of Mullerian abnormalities. A trend increase in the junctional zone disruption scores was observed within the higher order miscarriage groups. These trend differences were not statistically significant. There was a substantial interrater agreement in assessing the junctional zone disruption (weighted Cohen's kappa = 0.738. In this preliminary study, we described a new scoring system to assess the potential disruption of the endometrial junctional zone in patients with previous miscarriages. There might be an increased disruption in patients with multiple previous miscarriages.