Chronic endometritis is the most common endometrial pathology in women with habitual miscarriage. Urogenital infections, persistence of pathogenic and opportunistic flora lead to chronic inflammatory process in the endometrium and secondary immunodeficiency states. In the endometrium, an increased number of NK- (CD16+ and CD56+), В- (CD20+) lymphocytes and cells expressing the late HLA-DR activation marker are determined. These lymphocytes enhance the expression of histocompatibility antigens by endometrial cells and lead to autoimmune inflammation. The imbalance between immune tolerance to the fetus and immune activation to the pathogenic organisms is associated with poor pregnancy outcomes. After a course of complex therapy of chronic endometritis, most women with miscarriage can only reduce the severity of the inflammatory process in the endometrium. The aim of this study was to assess the importance of immunomodulatory effects of human immunoglobulin during pregnancy in women with miscarriage. The study included 182 patients with a history of miscarriage and chronic endometritis. Group 1 consisted of 98 women who received an intravenous course of human immunoglobulin at 7/8 weeks of pregnancy. Group 2 comprised 84 pregnant women who did not receive immunoglobulin therapy. An analysis of the results of the course and outcomes of pregnancy showed that administering an intravenous immunoglobulin course to pregnant women with miscarriage and chronic endometritis in the history prior to the first wave of trophoblast invasion helps to reduce the frequency of threatened abortion (54% in group 1 and 95% in group 2, p < 0.001). The data obtained suggest that intravenous immunoglobulin should be recommended for women with habitual miscarriage and chronic endometritis during pregnancy up to 8 weeks.
Permanent inflammation of the endometrium against the background of altered vaginal microbiota is accompanied by a violation of cyclic tissue changes. The revealed deficiency of the secretory phase of the cycle was formed independently of the synthesis of progesterone by the corpus luteum and led to impaired embryo implantation and miscarriage. Objective. To evaluate the efficiency of dydrogesterone in miscarriage in patients with chronic endometritis (CE) with luteal phase deficiency. Patients and methods. The study involved 127 women aged 25 to 40 years non-pregnant and during pregnancy with biopsyverified deficiency of the luteal phase of the cycle and CE of varying degrees of activity according to immunohistochemistry data. Women from group 1 (n = 83) continuously received dydrogesterone in a cyclic regimen from the moment of diagnosis until the 21st week of pregnancy; women from group 2 (n = 44) received dydrogesterone for 4 months of CE treatment, then it was discontinued and resumed again from the onset of pregnancy until the 21st week. Conclusion. There was no normalization of the structure of the endometrium after CE treatment with dydrogesterone removal from therapy in women with miscarriage and deficiency of the luteal phase of the cycle. Administration of dydrogesterone in a cyclic regimen with pregravid preparation before pregnancy, regardless of the initial level of progesterone in the blood, by women with miscarriage, CE and luteal phase deficiency contributes to normalization of morphological state of the endometrium in most patients, to significant decrease in the frequency of early miscarriage and duration of in-patient treatment, in contrast to women who canceled dydrogesterone. Key words: dydrogesterone, luteal phase deficiency, recurrent miscarriage, chronic endometritis
Резюме. У женщин с ановуляторным синдромом и нарушением репродуктивной функции персистирующая ациклическая гипоэстрогенемия и недостаточность прогестерона связаны с нарушением морфологической структуры эндометрия, повышенной экспрессией рецепторов эстрогенов, прогестерона, перераспределением NK-клеток с преобладанием CD16 + NK-клеток в эндометрии, при этом сниженное количество CD16 + NK-клеток и цитотоксических CD8 + Т-лимфоцитов в крови сочеталось с повышением уровнем IFNγ в сыворотке и увеличением спонтанной продукции TNFα. Ключевые слова: репродуктивная функция, гормональная недостаточность яичников, эндометрий, половые стероиды и их рецепторы, местный и системный иммунитет.
The indices of local immunity were studied by the immunohistochemical method in the endometrium from 151 women with morphological manifestations of chronic endometritis. To confirm the inflammatory process and clarify its nature, the parameters of systemic immunity were studied. According to changes in the parameters of local immunity, three groups of patients were identified. Determination of the parameters of systemic immunity made it possible to confirm chronic endometritis in all women and to identify a group with an autoimmune nature of inflammation.
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