Aim. To expand the understanding of the pathogenesis of chronic endometritis based on the study of reception and markers of cell proliferation/apoptosis in its various macrotypes depending on the nature of microbial colonization.Methods. We prospectively examined a group of 345 women with early reproductive losses (history of missed miscarriage, spontaneous abortion, artificial abortion, in vitro fertilisation failures during up to 6 months after intrauterine intervention), who had histologically verified chronic endometritis. A microbiological study of cervical discharge, aspirate from the uterus, identification of the pathogens with PCR, hysteroscopic and pathomorphological study of the endometrium (paypel biopsy) were performed. Identification of hysteroscopic hyperplastic, hypoplastic and mixed macrotypes was carried out on the basis of groups of features characterizing the thickness, color and the structure of the mucous membrane, intensity of vascular pattern in the presence of chronic inflammatory process. Immunohistochemistry of endometrium was performed to determine endometrial receptors for estrogen, progesterone («Dako», Denmark), proliferative activity of endometrial epithelial cells; the intensity of the expression of Ki-67 marker, that marks the cell nucleus at G1-, G2- and S-phase of the mitotic cycle, was taken into account. Apoptosis activity in endometrial biopsies was evaluated on the basis of expression of CPP32 proteins.Results. Structural and functional disintegration of the endometrium in chronic endometritis is presented as disorders of strictly determined submicroscopic features of the cellular elements of the glandular epithelium and stroma of the endometrium, however, each of the macrotypes has its own characteristic disturbances of homeostasis and homeokinesis of endometrial tissue.Conclusions. Further study of the markers of signaling pathways regulating proliferative cascades at the endometrial level matched with endometrial response to the invasion of a pathogen and morphological transformations will allow optimizing the diagnosis and treatment of chronic endometritis and restoration of reproductive potential after reproductive losses.
To evaluate the prognostic value of a comprehensive endometrial study after early reproductive losses (RL). A group of 306 women with early RL (missed abortion (n = 120), spontaneous miscarriage (n = 120), and ineffective in vitro fertilization attempts (n =66) were prospectively examined up to 6 months after the discharge of the uterus at the hospital bases of the Department of Obstetrics and Gynecology with the Сourse of perinatology at the PFUR Medical Faculty. Hysteroscopic macrotypes differentiation - hyperplastic (n = 89), hypoplastic (n = 94) and mixed (n = 87) - was carried out on the basis of features grouping characterizing the thickness, color and structure of the mucosa, the intensity of a vascular pattern in the presence of a chronic endometritis (CE). Evaluation of sonographic accuracy after hysteroscopic CE macrotypes differentiation showed the presence of false-negative conclusions: about unchanged mucosa (6.9%); endometrium polyps (3.5%); intrauterine synechiae (4.2%). Immunohistochemical staining with CD138 isolation showed higher diagnostic accuracy in CE detecting in comparison with the morphological method: in a hyperplastic macrotype (90.5% and 84.1%, respectively), hypo- (93.7% and 89.8%) and mixed (81.6% and 79.4%). Great diagnostic value is shown in identifying histopathic CE features in the context of hysteroscopic macrotypes differentiation in groups of women with RL.
Петров Ю.А., Блесманович А.Е., Алехина А.Г. ФГБОУ ВО РостГМУ Минздрава России, г. Ростов-на-Дону, Российская Федерация Аннотация. Установлено, что цитомегаловирусная инфекция распространена повсеместно. Процент людей, имеющих антитела к вирусу достигает внушительных цифр, что обусловлено многообразием путей инфицирования и почти стопроцентной восприимчивостью. Отмечено, что первичное заражение или активация инфекции во время беременности может приводить к осложненному ее течению, например, невынашиванию, плацентарной недостаточности, преждевременным родам. Показано, что существует достаточно высокий риск передачи вируса плоду. Большое значение имеет то, на каком сроке гестации началось заболевание и произошло заражение ребенка. Самым опасным считается первый триместр. При внутриутробном инфицировании в антенатальном, неонатальном и в последующих периодах может наблюдаться развитие тяжелых состояний и патологий, таких как ЗВУР, хроническая внутриутробная гипоксия, пороки развития, микроцефалия, хориоретинит, поражение печени, различные отдаленные последствия. Подчеркнуто, что методы терапии и спектр препаратов для лечения цитомегалии во время беременности весьма ограничены, так как противовирусные лекарственные средства в большинстве своем оказывают токсическое действие на развивающийся плод и могут приводить к негативным последствиям для здоровья будущего ребенка. Важную роль в предотвращении передачи цитомегаловируса от матери к плоду играет прегравидарная подготовка, целью которой является перевод активной формы инфекции в латентную. Ключевые слова: беременность, роды, ЦМВИ, внутриутробная ЦМВИ, прегравидарная подготовка. ESRD, chronic intrauterine hypoxia, malformations, microcephaly, chorioretinitis, liver damage, various long-term consequences can be observed. It is emphasized that an important role in preventing the transmission of cytomegalovirus from mother to fetus is played by pre-graft preparation, the purpose of which is to transfer the active form of infection into a latent one. The methods of therapy and the spectrum of drugs for treatment of cytomegaly during pregnancy is very limited, as antiviral drugs mostly have toxic effects on the development fetus and can lead to negative consequences for the health of the unborn child. An important role in preventing the transmission of cytomegalovirus from mother to fetus is played by pregravid preparation, the purpose of which is to transfer the active form of infection into a latent one. Annotation. It has been established that cytomegalovirus infection is ubiquitous. The percentage of people who have ATs to the virus reaches impressive figures, which is due to the variety of ways of infection and almost one hundred percent susceptibility. It is noted that the primary infection or activation of infection during pregnancy can lead to its complicated course, for example, miscarriage, placental insufficiency, premature birth. It is shown that there is a sufficiently high risk of transmission of the virus to the fetus. Of great importance is the timing o...
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