N 3 (184) 2023. P. 69–75

PATHOGENETIC PREREQUISITES FOR EARLY PREGNANCY LOSS

O. M. Nadvorna

Odesa National Medical University, Odesa, Ukraine

DOI 10.32782/2226-2008-2023-3-13

Early pregnancy loss is one of the most pressing problems today, as there is no single cause and simple methods of prevention. As a rule, placental dysfunction is formed against the background of problems associated with primary infection of the endometrium, progesterone deficiency, features of the local immune response to pregnancy. Placental dysfunction can, in turn, result in premature spontaneous termination in the early and late stages, premature detachment of the normally and low-situated placenta, stillbirths and preterm births with or without Massive Obstetric haemorrhage. Such complications pose a serious threat to the lives of not only the child but also the mother, requiring doctors to make every effort to save lives and save the families who have appeared in such situation. In this article we open the most common and often faced problems in carrying the baby. The first part of the article enlighten the specific details and effect of inflammatory process in relation to women’s past sexual history and the agents causing history and the agents causing the process of following chronic endometritis. The result of the long lasting chronic disease in endometrium and endomyometrium as well as first pregnancy termination leads to placental insufficiency appearance. The second part lights the hemodynamic disorders at women’s body which leads to miscarriages. The main problem in that case are clots in vessels which could be the manifestation of the AFL syndrome which contributes to the poor obstetric history and multiply miscarriages. The third part deals with local and general immune status which condition and role is not less than any other in successful pregnancy course.

Key words: early pregnancy loss, inflammatory diseases, immune system disorders, antiphospholipid syndrome.

REFERENCES

  1. Anchieva I.A. Clinical characteristics of placental dysfunction from the modern obstetrics view (literature review). Bukovinskyi Medychnyi Biulleten. 2016; 20 (1):196–199. Access mode: http://nbuv.gov.ua/UJRN/bumv_2016_20_1_46 (in Ukrainian).
  2. Borzenko I.B. Prognosis and early diagnosis of placental dysfunction (literature review). Ukrainskyi Zhurnal Meditsiny, Biologii i Sportu. 2020; 5; 2 (24): 7–17. DOI: 10.26693/jmbs05.02.007 (in Ukrainian).
  3. Boyko V.I., Radko V.Yu. Prevention of miscarriage in women with a history of chronic endometritis. Zdorovye zhenshchiny. 2016; 7: 112–114 (in Ukrainian).
  4. Brosens I. Great Odstetrical Syndromes are Associated with Disorders of Deep Placentation. Am j Obstet Gynecol, 2011, March; 204 (3); 193–201. DOI: 10.1016/j.ajog.2010.08.009.
  5. Diak K.V., Yuzko O.M. Causal factors of premature birth (a new look at the problem). Neonatolohiia, khirurhiia ta perinatalna medytsyna. 2017; 7 (1): 62–68 (in Ukrainian).
  6. Gladchuk I.Z., Nosenko O.M., Chueva-Pavlovskaya T.P., Kotyuga O.M. Retrospective analysis of pregnancy and childbirth in women with endometrioid disease. Visnyk Morskoyi Medytsyny. 2018; 1: 50–57 (in Ukrainian).
  7. Goshovska A.V., Birchak I.V., Goshovsky V.M. Prevention of placental dysfunction in women at risk – evaluation of results. Bukovynskyi Medychyi Biulleten. 2016; 20; 3 (79): 49–52. Access mode: https://core.ac.uk/download/pdf/144960628.pdf (in Ukrainian).
  8. Hunt K., Kennedy S.H., Vatish M. Definitions and reporting of placental insufficiency in biomedical journals: a review of the literature. European Journal of Obstetrics and Gynecology. 2016; 205: 146–149. DOI: 10.1016/j.ejogrb.2016.08.029.
  9. Kaminsky V.V., Kolomiychenko T.V., Boychuk O.G. et al. The role of disorders of vascular regulation perinatal complications incidence in high-risk pregnant women. Perinatologiia i pediatriia. 2016; 1 (65): 33–36. DOI: 10.15574/PP.2016.65.33 (in Russian).
  10. Kolomiichenko T.V., Yarotska Y.O. Optimized set of measures for prevention of preeclampsia, aimed at correction of endothelial dysfunction. Reproductive endocrinology. 2015; 5 (25): 88–92. DOI: 10.18370/2309-4117.2015.25.88-92 (in Ukrainian).
  11. Konkov D.V., Bulavenko O.V., Dudnik V.M., Buran V.V. Modern aspects of pathogenetically determined prevention of preeclampsia. Perynatolohiia i pediatriia. 2016; 1 (65): 46–50. DOI: 10.15574/PP.2016.65.46 (in Ukrainian).
  12. Laba O. Prevention of disorders of the fetoplacental complex in women at risk and risk of premature birth(Literature review). Reproduktyvne zdorovya zhinky. 2021; 2: 32–36. DOI: 10.30841/2708-8731.2.2021.232522 (in Ukrainian).
  13. McGregor J.A., French J.I. Pathogenesis to treatment: preventing preterm birth mediated by infection. Infectious Diseases in Obstetrics and Gynecology. 1997; 5; 2: 106–114. DOI: 10.1155/S1064744997000173.
  14. Microbiome in normal and pathological pregnancies: A literature overview / C.R. Taddei, R.V. Cortez, R. Mattar et al. American journal of reproductive immunology. 2018; 80, № 2: e12993. DOI: 10.1111/aji.12993.
  15. Minebois H., De Souza A., Mezan de Malartic C. et al. Endometriosis and miscarriage: Systematic review. Gynécologie, obstétrique, fertilité & sénologie. 2017; 45 (7/8): 393–399. DOI: 10.1016/j.gofs.2017.06.003.
  16. Mor G., Cardenas I., Abrahams V., Guller S. Inflammation and pregnancy: the role of the immune system at the implantation site. The Annals of the New York Academy of Sciences. 2011; 1221 (1): 80–87. DOI: 10.1111/j.1749-6632.2010.05938.x.
  17. Ovcharuk V.V. Clinical and pathogenetic aspects of diagnosis and prevention of placental dysfunction : the thesis of Candidate of medical sciences : 14.01.01. Ternopil, 2017. 213 p. (in Ukrainian).
  18. Romanova A. Treatment of inflammatory diseases of the pelvic organs – a modern challenge of antibiotic therapy. Zdorovya Ukrainy. 2021; 3: 12 (in Ukrainian).
  19. Rymarchuk M.I. Prevention of placental dysfunction in women with local non-progressive detachment of the normally located placenta. Galytskyi Medychnyi Visnyk. 2015; 22 (2): 86–89. Access mode: http://nbuv.gov.ua/UJRN/ glv_2015_22_3%282%29 24 (in Ukrainian).
  20. Saito S., Nakashima A., Shima T., Ito M. Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. American Journal of Reproductive Immunology. 2010; 63; 6: 601–610. DOI: 10.1111/j.1600-0897.2010.00852.x.
  21. Shcherbina I.M., Plakhotna I.Y. Features of violations of the state of the vaginal ecosystem in pregnant women with bacterial vaginosis. Wiadomości lekarskie. 2021; 74 (3): 460–464.
  22. The balance of the immune system between T cells and NK cells in miscarriage / A. Nakashima, T. Shima, K. Inada et al. American Journal of Reproductive Immunology. 2012. Vol. 67, № 4. P. 304–310. DOI: 10.1111/j.1600-0897.2012.01115.x.
  23. Volkov T.A., Bolshakova G.M. Microflora of the vagina in women of reproductive age in normal and with various pathologies (Literature review). Annals of Mechnikov Institute. 2009; 1: 5–14 (in Ukrainian).
  24. Warning J.C., McCracken S.A., Morris J.M. A balancing act: mechanisms by which the fetus avoids rejection by the maternal immune system. 2011; 141; 6: 715–724. DOI: 10.1530/REP-10-0360.
  25. Yarmak V.S., Benyuk V.O., Shcherba O.A. et al. Preliminary results of assessment of microbiocenosis of mucous membranes of the vagina, cervical canal and uterine cavity in women of reproductive age with endometrial polyposis. Zbirnuk naukovykh prats Asotsiatsii Akusheriv-Ginekolohiv Ukrainy. 2018; 2 (42): 225–230 (in Ukrainian).
  26. Zenclussen A.C. Adaptive immune responses during pregnancy. American Journal of Reproductive Immunology. 2013; 69; 4: 291–303. DOI: 10.1111/aji.12097.
View article PDF