PREDICTION OF PERINATAL COMPLICATIONS IN WOMEN WITH NONCARRYING OF PREGNANCY AT EARLY GESTATION TERMS (LITERATURE REVIEW)

Objective – to analyze modern views on the mechanisms of perinatal complications’development in order to predict them in women with miscarriage in the first trimester ofgestation.Conclusions. The need for further study of this problem, taking into account theethiopathogenesis, in order to develop algorithms for predicting gestational complicationsand timely diagnosis, which will improve perinatal outcomes, was shown. Therefore, thepriority task, aimed at reducing reproductive losses, is the prevention of miscarriage byfinding new screening markers that will detect preclinical forms of pathology.

Significance of endometrial dysfunction markers in the pathogenesis of chronic endometritis in women with reproductive losses

Introduction. A review of the literature considering the problem of reproductive health against the background of chronic endometritis is presented. According to the literature, in the etiology and pathogenesis of infertility and habitual miscarriage, the main cause is the «uterine factor» (24-62%). Chronic inflammation in the uterine mucosa can lead to infertility, which increases the significance of this pathology. It is proved that most often the causative agents of this disease are representatives of conditionally pathogenic microflora. Chronic endometritis is an unexplored pathology associated with unfavorable reproductive outcomes, such as unsuccessful implantation and repeated miscarriage. Most scientists assume that inflammation develops against the background of a long-term persistence of an infectious agent. According to other scientists, the cause of the occurrence and development of chronic endometritis is an autoimmune process that contributes to the progression of inflammation. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system. In this article, we aim to give an overview of the diagnosis, etiology, pathophysiology and treatment of chronic endometritis, its effect on endometrial receptivity and its relationship with reproductive dysfunction.The aim of the study is to identify the main discussed aspects of the management of patients with chronic endometritis, to determine promising diagnostic methods.Materials and methods. The analysis and systematization of the data were carried out on the basis of scientific publications in the common database of Cyberleninka and PubMed.Results and Discussions. The article discusses the methods of laboratory, ultrasound and instrumental diagnostics used in Russia and abroad. The» gold standard « of diagnostics is a histological examination of the endometrial tissue material on the 7th10th day of the menstrual cycle. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system.Conclusion. Chronic endometritis remains an important problem in modern society, as it has a social significance: the frequency of reproductive losses is at a high level. There is a need to further study the features of the etiology and pathogenesis of chronic endometritis in order to improve the presentation of the course of the inflammatory process and improve the methods of therapy and prevention of this disease for the realization of reproductive function.

Placental markers of miscarriage

Successful implantation involves a high degree of development of spiral arteries, combined with high proliferative activity, which ensures the formation of a healthy placenta, full uterine-placental circulation, and the birth of a healthy child. The placenta is the unique organ of the biological monitoring, the mirror of pregnancy. Identification of placental markers of miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to identify the markers of miscarriage and premature labor in the structures of the chorion and placenta. Materials and methods. The main group included tissue samples of the 22 chorions and 64 placentas after termination of current pregnancy from women with a history of reproductive losses. The control group included tissue samples of the 20 chorions after artificial abortion and 20 placentas after physiological pregnancy and birth. The placenta was examined according to the protocol (form No. 013-1/0). The expressions of VEGF, CD31/PECAM1, CD105/Endoglin/TGFβ 1/3 Receptor, Bcl-2α Ab-1, TNF-α, CD45/T200/LCA, CD56/NCAM1 were studied in the structures of chorion and placenta by immunohistochemistry. Results. Based on histological and immuno-histochemical study of chorion and placenta samples in women with reproductive history and termination of the current pregnancy, it was established that embryo-endometrial dysfunction is the cause of miscarriage in the first trimester, and inflammation is the precondition of preterm birth; markers of miscarriage and premature labor in the structures of the chorion and placenta have been identified. Conclusions. The markers of miscarriage are pathomorphological changes in endometrium and chorion combined with high expression of TNF-α and NK-CD56, low expression of CD31/PECAM1, negative expression of VEGF to indicate a violation of cytotrophoblast invasions. The markers of inflammation and premature labor are structural and functional changes of placenta in combination with moderate expression of TNF-α in syncytium, high expression of NK-CD56 in villous stroma, high expression of CD45/T200/LCA in the decidual membrane.

Toxoplasma gondii is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: a prospective cohort study

Background Toxoplasma gondii causes reproductive losses in sheep worldwide, including Australia. The reproductive performance of primiparous ewes is typically lower than for mature multiparous ewes, and younger ewes are more likely to be immunologically naïve and therefore more susceptible to reproductive disease if T. gondii infection occurs during pregnancy. The aim of this study was to assess the impact of infection with T. gondii on the reproductive performance of primiparous ewes in southern Australia using a prospective cohort study. This will inform the need for targeted control strategies for T. gondii in Australian sheep. Results Toxoplasma gondii seropositivity using indirect ELISA was detected at 16/28 farms located across southern Australia. Apparent seroprevalence was lower in primiparous ewes (1.1%, 95% confidence interval (CI) 0.6, 1.8) compared to mature multiparous ewes (8.1%, 95% CI 6.0, 10.5; P < 0.001). Toxoplasma gondii seroconversion during the gestation and lambing period was confirmed for 11/1097 (1.0%, 95% CI 0.5, 1.7) of pregnant primiparous ewes that failed to raise a lamb, and 1/161 (0.6%, 95% CI 0.1, 2.9) primiparous ewes with confirmed abortion. Toxoplasma gondii was not detected using qPCR in tissue samples from aborted or stillborn lambs (n = 35) from a subset of six farms. Conclusions Low seroprevalence and low incidence of seroconversion during gestation suggests that toxoplasmosis was not an important contributor to reproductive losses in primiparous ewes on farms located over a wide geographical area in southern Australia.

Modern view of the problem of missed abortion

Non-developing pregnancy is an urgent obstetric problem, which is included in the structure of reproductive losses and. The authors performed a systematic analysis of the data presented in the modern scientifi c literature on the epidemiology, etiology, pathogenesis, and diagnosis of non-developing pregnancy. Th e review includes data from foreign and domestic articles on this topic found in PubMed over the past 7 years.