IMPACT OF PREVENTIVE THERAPY ON REGULATING MECHANISMS OF DECIDUAL MACROPHAGE POLARIZATION IN PREGNANT WOMEN WITH HIGH RISK OF PREECLAMPLSIA.

OBJECTIVE: The aim: This study was aimed at analyzing the impact of preventive therapy for pregnant women at a high risk to develop preeclampsia on the normalization of the mechanisms of decidual macrophage polarization. PATIENTS AND METHODS: Materials and methods: The methodology was designed to obtain data on the content of pro- and anti-inflammatory cytokines and indicators of nitric oxide and arginase metabolism in cervical mucus. The ration between M1 / M2 decidual macrophages in the placenta was determined by applying immunohistochemical methods. The effectiveness of the proposed therapy for the secondary prevention of preeclampsia (metformin, vitamin D3 and corvitin) was evaluated. RESULTS: Results: Pregnant women with preeclampsia showed the imbalance between pro- and anti-inflammatory cytokines in favour of TNF-α and INF-γ under the decrease in IL-10 that results in an imbalance in the activity of enzymes regulating L-arginine metabolism, with increased iNOS activity and decreased arginine activity. In the placentas of the pregnant women with preeclampsia, in contrast to the healthy pregnant women, M1 decidual macrophages are found as predominant. The women, who received the course of the preventive therapy with metformin, vitamin D3 and corvitin, showed a decrease in the concentration of pro-inflammatory cytokines and an increase in anti-inflammatory cytokine IL-10, normalization of the balance between iNOS and arginase activity, and the normalization of the M1 / M2 macrophages ratio. CONCLUSION: Conclusions: Normalization of the balance between pro- and anti-inflammatory cytokines, iNOS and arginase activity in cervical mucus, the ratio between decidual M1 and M2 macrophages as results of the therapy proposed reduce the incidence of preeclampsia and associated complications.

THE ROLE OF SECRETING FUNCTION OF DECIDUA IN THE DEVELOPMENT OF COMPLICATIONS OF GESTATION PROCESS IN PREGNANT WOMEN WITH A PAST HISTORY OF CHRONIC ENDOMETRITIS.

OBJECTIVE: The aim: To determine the serum FAMG in the I and II trimester of pregnancy in women with a past history of chronic endometritis, and to clarify its impact on the development of pathology of pregnancy. PATIENTS AND METHODS: Materials and methods: The level of FAMG was determined at 6-8 and 16-18 weeks of gestation in 135 pregnant women with a past history of chronic endometritis, who received treatment of chronic endometritis at the stage of pregravid preparation and 168 women who became pregnant without its prior treatment. The dependence of the development of pre-eclampsia on the level of FAMG at the early stages of pregnancy has been evaluated. RESULTS: Results: At 6-8 weeks of pregnancy, the level of FAMG in women with a past history of chronic endometritis was 20.6% lower (122.4 ± 7.6 ng/ml) compared to the control group. In FAMG of 90.3 ± 4.3 ng/ml at 6-8 weeks of gestation, spontaneous abortion occurred in 100% of cases within the next 2 weeks. FAMG lower than 122,1 ± 3,0 ng/ml can be the predisposing factor for the development of pre-eclampsia. CONCLUSION: Conclusions: Reduced FAMG in the beginning of pregnancy in women with untreated chronic endometritis in the past history increases the incidence of miscarriages at the early stages by 2.6 times, and by 1.8 times the probability of preeclampsia development. Treatment of chronic endometritis at the stage of pregravid preparation promotes the increase of FAMG by 24,6% compared to untreated women that reduces the probability of complications during the subsequent course of pregnancy.

Possibility for non-invasive diagnosis of chronic endometritis in women at risk during pregravid preparation.

OBJECTIVE: Introduction: Detection and treatment of chronic endometritis (CE) is clinically significant, though involves intrauterine intervention to collect endometrium. The aim: To estimate the possibility to use fertility α2-microglobulin (FAMG) as the marker of the high risk for CE. PATIENTS AND METHODS: Materials and methods: 70 women with CE who were planning pregnancy were tested for FAMG in menstrual blood. 40 of them received treatment of CE. The other 30 women refused from the proposed treatment. The control group involved 30 women who had neither CE nor luteal phase deficiency (LPD). Additional group (20 women) had LPD without CE. RESULTS: Results: The decrease of FAMG by 2.4 times was noted in women with CE (16.3 ± 3.9 µg/ml against 39.8 ± 8.3 µg/ml in the controls). In LPD the index was 5.6 times lower. After treatment the level of FAMG was increasing. CONCLUSION: Conclusions: The decrease of the amount of FAMG in menstrual blood is specific for women both with CE and LPD. Detection of abnormally low rates of FAMG in all women with CE enables, with the exception of absolute hypoprogesteronemia and LPD, using it as a simple method of estimation of the functional state of endometrium. Its application can be very useful both for non-invasive diagnosis of CE and subsequent evaluation of treatment of this pathology.