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.

1 ФГБНУ «НИИ аГир им. д. О. Отта», санкт-Петербург; 2 сПбГБУЗ «родильный дом № 1 (специализированный)», Центр профилактики и лечения невынашивания беременности; 3 ФГБОУ ВО «санкт-Петербургский государственный университет» ■ Цель исследования. Выяснить частоту встречаемости антифосфолипидных антител среди пациенток с репродуктивными неудачами и определить алгоритм ведения этих больных. Материалы и методы. Обследовано 2150 женщин, из них 1650 с привычным невынашиванием беременности в анамнезе, 450 женщин с бесплодием и 50 соматически и гинекологически здоровых женщин. Результаты. У женщин с отягощенным акушерско-гинекологическим анамнезом повышенные уровни АФА встречаются в 24 % наблюдений при привычном невынашивании беременности и в 20 % случаев при бесплодии. Прегравидарная подготовка и постоянный мониторинг состояния пациенток эффективно снижает частоту неблагоприятных исходов беременности. Выводы. Представлен опыт работы по ведению женщин с антифосфолипидным синдромом и привычной потерей плода. Показано, что адекватная оценка их состояния, прегравидарная подготовка, методичное и внимательное наблюдение в течение беременности позволяет довести беременность до рождения жизнеспособного плода. ■ Ключевые слова: антифосфолипидный синдром; невынашивание беременности; антитела к бета-2 гликопротеину-1. ■ Purpose: the frequency of antiphospholipid in patients with reproductive failures was defined. The algorithm of the treatment of these patients was presented. Materials and methods: the study included 2150 patients: 1650 with a history of the repeated pregnancy losses; 450 with sterility and 50 healphy women. Results: the high levels of AFA were founded in 24 % of patients with spontaneous abortions and in 20 % of patients with sterility. Conclusion: Pregravid preparation and permanent monitoring the state of patients reduce frequency of unfavorable ends of pregnancy effectively.■ Key words: antiphospholipid syndrome; recurrent miscarriage; anti-beta glycoprotein I antibodies.

Introduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimesterфIntroduction. Abnormal vaginal microflora in the first trimester of pregnancy is a risk factor for miscarriage. Opportunistic microorganisms predominate among microorganisms causing microflora disturbance. Aim. The aim of the study was to evaluate the vaginal microflora in the first trimester of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.of pregnancy in women having history of pregnancy loss. Matherials and Methods. Real-time polymerase chain reaction, microscopic and cultural methods were used to examine 60 pregnant women having history of pregnancy loss and 10 pregnant women with uncomplicated obstetric history. Results. Disorders of the vaginal microflora were observed only in women having history of pregnancy loss. The lactoflora in both groups was shown to consist most frequently of 3 Lactobacillus species: Lactobacillus crispatus, L. jensenii, and L. iners. However, the species L. iners were detected only in the group of women with history of pregnancy loss. Non-Lactobacillus microbiota was significantly more often observed in pregnant women having history of pregnancy loss. Facultative and obligate anaerobes were detected in both groups. The concentration of Ureaplasma spp. and Mycoplasma hominis in women in both groups had no significant differences. Conclusions. The results of this study indicate that abnormal microbiota is more often observed in women having history of pregnancy loss.

The aim of this study was to improve the method for diagnosing insulin resistance (IR) and to assess the effect of pregravid diet alone or dietary supplementation in combination with metformin on the development of gestational diabetes mellitus (GDM) and its complications in patients with pre-diabetes. At the first stage of the study, glucose level was determined in the capillary blood of 61 women and, in the second stage, in the venous blood plasma of 60 individuals. The 75 g oral glucose tolerance test was performed in all patients. Plasma insulin level and IR index were determined basal (HOMA-IR) and two hours after the glucose load. The presence of IR was found in 68 women. All of them were treated with a diet, with 34 patients additionally treated with metformin at a dose of 1500 mg per day. The duration of therapy was 3-6 months.It has been shown that the evaluation of IR index two hours after the glucose load significantly (p < 0.05) increases the diagnosis of the IR status, as in 56.5% of women with IR, the fasting IR (HOMA-IR) values were normal. The use of metformin combined with diet therapy in patients with IR, with easily assimilated carbohydrates excluded at the pregravid stage, is accompanied by a more significant loss of body weight with the achievement of a normal body mass index for pregnancy, when compared to diet therapy alone. In patients with IR after pregravid treatment with diet or diet with metformin, the frequency of obstetric complications, as well as of gestational diabetes mellitus, is comparable with that in normal women. In addition, such pregravid treatment protects patiens with IR from superfluous weight gain and fetal macrosomia. (For citation: Komarov ЕК, Pluzhnikova ТА, Nikologorskaya ЕV, Alyabyeva ЕА. Role of pregravid diet and metformin in the prophylaxis of gestational diabetes and its complications. Journal of Obstetrics and Women’s Diseases. 2018;67(4):13-18. doi: 10.17816/JOWD67413-18).