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.

In the prevention of miscarriage, women's consultation plays a leading role.

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

The aim of the study was to evaluat`e the use of the drug duphaston: 1) to prepare for an upcoming pregnancy in women with hyperandrogenism and insufficiency of the luteal phase of the cycle; 2) to treat the threat of termination of pregnancy in women with a history of miscarriage. The use of duphaston in women suffering from miscarriage has confirmed its high efficiency both in preparation for pregnancy in patients with hyperandrogenism and insufficiency of the luteal phase of the menstrual cycle, and in the treatment of threatened abortion. In 93.5% of women with a history of 100% fetal loss, it was possible to bring the pregnancy to delivery.

Tasks of investigation were concluded the characterization of insulin resistence (IR) and hormonal features in patients with prediabetes and influence of diet or metformin on the course of pregnancy and perinatal complications. There were examined 61 womans. The OGTT, definition of insulin levels in plasma and index IR were performed in all patiens. OGTT and index IR were normal in 14 womans (control group I). OGTT was normal but index IR was impared in 33 womans (group IR - II). From this group 22 womans were treated with diet (II A group) and 11 womans treated with metformin (IIB group). OGTT and index IR were abnormal in 14 womans (impared OGTT - III group), they were treated with metformin. Dose of metformin was 1500 mg/d, threatment was continueted for 3-4 manths. Conclusion: Used indexes IR basal and two hour after glucose load were significant in definition of normal and decreased insulin sensitivity (IR). Presence of IR is accompanied by high level of free testosterone in blood without impared secretion of ovarian and suprarenal androgens. There was impared sensitivity of endometrium of secretory stage. The frequency of obstetric and perinatal complications in patients receiving diet not differ from patients treated with metformin. There was only a tendercy to low frequency of threatening miscarriages befor 12 weeks of gestations in paitiens receiving metformin. Development of GDM was observed in 13,1 % of patiens only with presence of IR. The use of metformin in pregravidal stage preserved the development of macrosomia in offsprings of patients with prediabetes.