Імуногістохімічні особливості експресії прогестеронових рецепторів плацентарного бар'єра в жінок із багатоплідною вагітністю, що зумовлена ДРТ 1 ДУ «Інститут педіатрії, акушерства і гінекології НАМН України», м. Київ, 2Національний медичний університет імені О. О. Богомольця, м. Київ Ключові слова: прогестеронові рецептори, плацента, імуногістохімія, багатоплідна вагітність, ДРТ.Гормональні порушення є однією з основних відомих причин, що призводять до невиношування вагітності та передчасних пологів при багатоплідній вагітності, котра зумовлена допоміжними репродуктивними технологіями (ДРТ). Роль прогестерону та кількості його рецепторів відіграють важливу роль у збереженні та пролонгації вагітності. Вивчення плацент як основного місця синтезу прогестерону має високий інформативний потенціал та є найважливішим діагностичним об'єктом, а отримана при його дослідженні інформація абсолютно необхідна для повноцінного висновку про причини, механізм близьких і віддалених наслідків патології багатоплідної вагітності.Мета роботи -вивчення імуногістохімічних особливостей посліду у породіль із біхоріальною біамніотичною двійнею при спонтанному заплідненні та після застосування допоміжних репродуктивних технологій (ДРТ).Матеріали та методи. Обстежили 94 жінки, 44 з них мали багатопліддя, що зумовлене ДРТ, 42 -із самостійним багатопліддям і 38 жінок -з одноплідною вагітністю. Здійснений клініко-статистичний аналіз перебігу вагітності, пологів у групах, котрі досліджували.Встановили, що багатоплідна вагітність, котра зумовлена ДРТ, належить до гестації високого ступеня ризику, під час якого передчасні пологи трапляються значно частіше, ніж при одноплідній вагітності.Виявили, здійснивши імуногістохімічне дослідження плацент, найбільшу експресію прогестеронових рецепторів в ядрах децидуальних клітин (45%), що належать до материнської структури плаценти від жінок із багатопліддям, котре зумовлене ДРТ. Також виявили, що зі збільшенням терміну гестації спостерігається вірогідне зниження активності експресії прогестеро-нових рецепторів (від 45 до 2,5%) незалежно від способу зачаття й кількості плодів. Отже, результати дослідження вказують на безперечний зв'язок структур плацентарно-ендометріальних взаємовідносин, що є важливим компонентом у доцільності гормональної терапії. Иммуногистохимические особенности экспрессии прогестероновых рецепторов плацентарного барьера у женщин с многоплодной беременностью, обусловленной ВРТ Т. Д. Задорожная, Б. М. Венцковский, С. М. Килихевич, И. В. ПоладичГормональные нарушения являются одной из основных известных причин, приводящих к невынашиванию беременности и преждевременным родам при многоплодной беременности, обусловленной вспомогательными репродуктивными технологиями (ВРТ). Прогестерон и количество его рецепторов играют важную роль в сохранении и пролонгации беременности. Плацента как основное место синтеза прогестерона имеет высокий информативный потенциал и является важнейшим диагностическим объектом, а полученная при её исследовании информация совершенно необходима для полноценного заключе...

The objective: a study of the electronic microscopic features of the decidual membrane in pregnant women with placenta previa. Materials and methods. 122 pregnant women with atypical location of the placenta were examined and delivered within 36 weeks+6 days and 38-39 weeks of gestation in Kyiv Perinatal Center during 2014–2020. Electronic microscopy of the decidual membrane was performed in 10 pregnant women with placenta previa. Decidual membrane biopsy was performed directly from the site of placenta previa and from the uterine body outside the placenta previa. Results. By placenta previa the endometrial glands penetrate deep into the myometrium in the border zone of the endometrium with the myometrium, some of them lose the basement membrane in the epithelium, and the enlarged tubules of the granular endoplasmic reticulum are located in its cytoplasm. Most of them are without ribosomes, which formed autophagosomes in the cytoplasm or outside it. A large number of dictyosomes were found. In most of the epithelial cells, the plasma membrane is not preserved and the cytoplasm is in direct contact with the myometrium or connective tissue or is lysed.Examination of the decidual membrane in the body of the uterus outside the placenta previa demonstrated that the decidual cells are surrounded by a basement membrane, have a polygonal shape, contain many glycogen inclusions in the form of small dense granules – beta-particles and granules which form the clusters in the form of rosettes – alpha-particles. Their content is washed out of fat inclusions, and the cytoplasm of decidual cells, in the late period of observation, loses the content of trophic inclusions and, accordingly, energy supply. The lumens of blood vessels are filled with electronic dense content or are completely obstructed by accumulations of blood plasma proteins, fibrin, cellular detritus of blood cells, which contributes to the formation of blood clots. The smooth muscle cells of these vessels are compacted and located in the clefts of the basement membranes of epitheliocytes and their own basement membranes. Conclusions. In the decidual membrane directly in the area of ​​placenta previa in the lower segment of the uterus, the foci of decidualization significantly expand and push the endometrial glands into the myometrium. The basement membrane of the endometrial epithelium is lysed, its structural organization is disrupted and its contents are homogenized, which leads to an increase in the permeability of the decidual membrane. Blood-forming elements, in particular leukocytes, cellular detritus and the significant growth of collagen and elastic fibers impede interstitial transport of the intercellular substance that leads to the systemic disorganization of connective tissue, damage of vessels of a hemomicrocirculatory channel and the increase in immunopathological processes. In turn, the loss of the inclusions by the decidual cells leads to a disorder of trophic decidual membrane in the uterine body by placenta previa in the lower segment of the uterus.

The article is devoted to the detection of interleukin circulation of different classes in women with multiple pregnancies depending on the method of fertilization and gestational age.The study found that the concentration of pro-inflammatory cytokines IL-1 (126.8 pg/mg) and IL-8 (176.4 pg/mg), determined in the 22nd week of pregnancy in the serum of patients with multiple pregnancies due to using ART, probably exceeded the control group (48.7 and 39.3 pg/mg) and spontaneous multiple pregnancy (49.3 and 40.6 pg/mg). Concentrations of cervical IL-1 and IL-8 were also elevated in pregnant women receiving ART compared with women with spontaneous multiple births and controls. These changes were observed in the dynamics of pregnancy. Under the influence of our recommended therapy, there was a gradual decrease in IL-1 and IL-8, which no longer differed from those of women with spontaneous multiple pregnancies and the control group. Administration of natural micronized progesterone for immunosuppression (normalization of the cytokine profile) to patients with multiple pregnancies due to the use of ART, reduced the incidence of preterm birth (from 83.3 to 43.7%), weakness of labor (33.3 and 21.9%, respectively), PRPO (22.2 and 12.5%, respectively), to reduce perinatal morbidity from 45.5 to 19.7% and mortality from 43.1 to 9.5%, which was not detected in patients with spontaneous fertility.Determining the features of cytokine imbalance in women with multiple pregnancies depending on the method of fertilization provides new approaches to the prevention and treatment of miscarriage, which will benefit mothers in different clinical situations.

The article presents modern phenomena about morphological and electron microscopic features of the studied placentas in very early premature birth, complicated by premature rupture of membranes. These features were studied in different tactics of data management of pregnant women. The objective: study of morphological and electron microscopic features of the studied placentas in very early preterm birth, complicated by PRPO.Materials and methods. All 206 patients were divided into two groups. The main group included 150 pregnant women with PRPO at a gestational age of 22–28 weeks, and the control group included 56 pregnant women with a physiological course of gestation at a period of 22–28 weeks. The main group is divided into 2 groups depending on the duration of waiting tactics and the method of delivery. Group I patients received treatment in accordance with clinical protocols by orders of the Ministry of Health of Ukraine. Pregnant women of group II were offered a tactic that involves prolonging gestation for 5 days (antibiotic therapy, RDS prophylaxis, magnesium therapy, in the presence of streptococcus B – treatment) followed by delivery by cesarean section. All patients with PRPO received antibacterial therapy from the day of hospitalization. Results. The results of the study indicate that no significant differences between the study groups during the study were found. The expression data of progesterone receptors correspond to the results of hormonal research, which also did not reveal significant changes in the study groups, and confirm the theory of finding new provoking factors of PRPO in preterm birth. Conclusions. Thus, it was first demonstrated that the content of progesterone in blood plasma and immunohistochemical expression of progesterone receptors in the placenta on the background of DRPP depends on the gestational age and not on the duration of the anhydrous period.

The article presents modern phenomena about electron microscopic features of the studied placentas. Placenta previa is an urgent problem of modern obstetrics, as it is the main cause of obstetric bleeding in the third trimester of pregnancy. The aim of the study was to study the electron microscopic features of the myometrium of the lower uterine segment in women with placenta previa. Materials and methods. In accordance with the aim of the research, 122 pregnant women with atypical location of the placenta were examined, who were hospitalized and delivered in the Perinatal Center of Kyiv during 20140–2020 at 36 + 6 days and 38–39 weeks of gestation. In 10 pregnant women with placenta previa performed electron microscopy of the myometrium of the lower uterine segment during placenta previa, which formed the main group. The control group included 6 pregnant women within 38 weeks with a normal location of the placenta. In all pregnant women of the main group, myometrial biopsies were taken in the placenta previa of the lower uterine segment. Results and their conclusions. The study found that the most significant electron microscopic changes were found in the myometrium, which is primarily related to the contractile function of smooth myocytes. Obviously, this is due to lack of energy supply, resulting in a decrease in both the number of mitochondria and their functional state. This process is also complicated by other energy sources – trophic inclusions. The condition of blood vessels at presentation of a placenta also changes, both a hypoxic condition of vessels, and surrounding fabrics develops. The detected electron microscopic changes of the placenta give an understanding of the further course of pregnancy and fetal development, because it is the placenta that ensures the interaction of the mother and fetus.