[Endometrial morphological characteristics in patients with hysteromyoma and chronic endometritis in infertility]. / Morfologicheskaia kharakteristika éndometriia u patsientok s miomoi matki i khronicheskim éndometritom pri besplodii.

OBJECTIVE: To characterize endometrial structural and functional state and receptivity in women with hysteromyoma (HM) and chronic endometritis (CE) in infertile couples. MATERIAL AND METHODS: A total of 130 patients who had HM and/or CE in an infertile couple were examined. Group 1 included 64 women with HM and CE; Group 2 consisted of 24 patients with HM; group 3 comprised 42 patients with EC. A control group included endometrial biopsy specimens from 20 healthy women planning a pregnancy. RESULTS: Patients with HM and CE were found to develop endometrial dysfunction. Its structural signs were damage to the endometrial surface epithelium; intense stromal fibrosis with the high expression of type III and IV collagens; dysregulated processes of high angiogenesis; impaired maturation of pinopodia by the implantation window; high estrogen receptor (ER) expression in the nuclei of endometrial glandular and stromal cells; low progesterone receptor (PR) expression; and impaired secretory endometrial transformation. CONCLUSION: HM concurrent with CE is responsible for endometrial dysfunction. Its structural manifestations are mainly associated with CE.

[Preventability of perinatal losses by the example of the large industrial cities Chelyabinsk and Novosibirsk]. / Predotvratimost' perinatal'nykh poter' v Cheliabinske i Novosibirske.

Perinatal mortality rate is an indicator that characterizes the quality of medical care, as well as the social and economic situation in the region. OBJECTIVE: to audit perinatal losses in large regional centers of the Russian Federation with a population of over 1 million inhabitants, such as Chelyabinsk and Novosibirsk. MATERIAL AND METHODS: A comprehensive postmortem examination of 309 cases of perinatal losses in 2016 was made, which was supplemented with an assessment of preventability according to the Scandinavian-Baltic classification. RESULTS: The rate of preventable deaths in Chelyabinsk and Novosibirsk amounted to 91 and 81.5% of cases, respectively; the deaths were due to stillbirths at more than 28 weeks' gestation and to dead newborns in almost half of cases. The proportion of intranatal deaths was shown to increase in Chelyabinsk; the number of neonatal deaths at more than 33 weeks' gestation rose in Novosibirsk. CONCLUSION: Supplementing the traditional clinical and postmortem analysis with an assessment of the preventability of perinatal loss makes it possible to ensure a unified approach to evaluating these conditions and the comparability of autopsy results in different subjects of the Russian Federation and to determine regional reserves for reducing perinatal mortality rates.

[Morphofunctional characteristics of impaired endometrial receptivity in chronic endometritis].

OBJECTIVE: To evaluate endometrial receptivity in women with chronic endometritis (CE), by studying the nature of secretory transformations, the number of mature pinopodia in the surface epithelium, the expression of steroid hormone receptors and leukemia inhibitory factor (LIF). SUBJECTS AND METHODS: Endometrium morphology was analyzed in 76 patients with CE (a study group) and 20 gynecologically healthy women (a control group) who sought family planning advice and examined using the uniform scheme. Morphological examination of the endometrium obtained by Pipelle biopsy on days 7-8 after ovulation involved histological and immunohistochemical studies: the number of mature pinopidia and the expression of estrogen and progesterone receptors (ER and PR) were determined, by estimating the PR/ER ratio and the marker of LIF receptivity in the endometrial epithelium and stroma. RESULTS AND DISCUSSION: In the women with CE, the level of surface epitheliocytes with pinopodia was significantly lower than that in the comparison group (mean 37.5 +/- 2.1; p < 0.01). There was an increase in ER expression in the integumentary and glandular epithelium (mean 102.5 +/- 6.8 scores; p < 0.01) and stromal cells (110.2 +/- 8.3 scores; p > 0.05). In the control group, the intensity of PR expression was, on the contrary, significantly lower in both the integumentary epithelium and glandulocytes (mean 104.7 +/- 5.5 scores; p < 0.01) and stromal cells (178.5 +/- 11.3 scores; p < 0.01). In the study group, the PR/ER ratio was less than 2 in all cases: the mean PR/ER ratio was 1.1 +/- 0.09 for surface epitheliocytes and glandulocytes and 1.6 +/- 0.1 for stromal cells. In CE, the intensity of LIF expression was dramatically reduced and equal to 0.95 +/- 1.3 scores (p < 0.01). The found regularities suggest that CE is accompanied by an almost 4-fold decrease in LIF expression, which is evidence for significantly suppressed endometrial receptivity and may be regarded as a prognostic marker of failed implantation. CONCLUSION: The patients with CE were found to have an endometrial receptivity disorder involving the damaged surface epithelium of the uterine mucosa, pinopodia immaturity by the implantation window, decreased LIF expression, and ER hyperexpression. This may give rise to reproductive dysfunction in women with CE.

[Giant chorioangioma of the placenta].

The paper describes a case of giant (123 x 109 x 70-mm) placental chorioangioma that is a capillary hemangioma in structure, which led to significantly impaired placental-fetal blood flow to give rise to non-immune hydrops and right heart failure in the fetus at 33 weeks' gestation; obvious polyhydramnios developed. This served as an indication for preterm one-stage cesarean delivery. A premature live girl was born with a weight of 2430 g, a height of 44 cm, Apgar score 6-7. Dynamic echographic monitoring makes it possible to record increased placental tumor sizes and fetal abnormalities and to make a timely decision on delivery, which promotes perinatal death prevention. At 11-month follow-up, the child's physical and mental developments were for age.

[Uterine mucosal morphofunctional characteristics in women with early miscarriages of infectious genesis].

Eighty-two reproductive-aged patients who had early miscarriages of infectious genesis were examined. Group I comprised 56 women who had a history of one spontaneous miscarriage; Group 2 included 26 patients with a history of 2 spontaneous miscarriages or more. The examination used a set of diagnostic tools for the identification of genital infections and histological, histochemical, and statistical studies. Group 2 patients were ascertained to have more frequently infectious inflammatory genital diseases. In the women of both groups, chronic endometritis of mainly Ureaplasma, Mycoplasma, and viral etiologies was recorded in 100% of cases while that of mixed etiology was observed in 57%. Moreover, the signs of endometrial stromal fibrosis and atrophy, receptor apparatus lesion, and suppressed tissue protective immune reactions were significantly more evident in Group 2 patients.

[The characteristics of the epithelium and endometrial extracellular matrix in miscarriage during early pregnancy associated with chronic endometritis].

In miscarriage associated with chronic endometritis, the uterine mucosa was found to have a lower expression of TGFR-beta, gelatinases and a higher exposure of TIMP-1 and EGFR, which confirms a pathogenetic association between the imbalance of growth factors, endoproteases and their inhibitors and points to the active involvement of these cytokines and endopeptidases in the inflammatory, reparative processes and remodeling of tissues. The imbalance of growth factors, proteases, and antiproteases is likely to be a cause of uterine mucosal remodeling with progressive collagenogenesis and atrophy of the glandular apparatus along with pathogen persistence, which may be one of the factors predisposing to miscarriage. This makes it necessary to eliminate the causative agent of the endometrial infectious-inflammatory process in the earliest periods of the onset of disease and permits the drawing up of approaches to targeted drug therapy for some pathogenetic links of disease.

[Endometrial pathomorphology in bacterial vaginosis associated with chronic endometritis].

A complex morphological and morphometric study was used to examine endometrial biopsy specimens from 133 patients with bacterial vaginosis (BV). Chronic endometritis (CE) was detected in 100% of them. The morphological components of CE in BV were significant dystrophic changes in integumentary endotheliocytes and glandular cells, differently pronounced polymorphocellular infiltration of the uterine mucosa with signs of tissue lymphopenia, as well as stromal and vascular fibroblastic changes with the decreased volume density of the endometrial integumentary endothelium, lower relative volumes of glands, and increased relative volume of connective tissue. The characteristic structural changes for CE and BV are intensive processes of apoptosis of the uterine mucosal epithelium in the presence of its slight proliferative activity, which determines progressive endometrial atrophy and may contribute to non-developing pregnancy. As this takes place, discrinism occurs in the uterine mucosa, mainly as inadequate progesterone reception of endometrial target cells, which leads to uterine gland dysfunction and may also cause fetal depletion syndrome.