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The problems of pathological diagnosis of recurrent miscarriage are relevant in modern reproductive medicine. One of the important molecular markers of endometrium is the progesterone-induced blocking factor, which is induced by progesterone under the influence of activated lymphocytes and has an immunomodulatory effect on the implantation characteristics of the endometrium. In the process of trophoblast invasion, a special role is also played stromal cell factor molecules synthesized by endometrial and trophoblast cells, as a mechanism that potentiates the susceptibility of the endometrium to the onset and development of pregnancy, trophoblast invasion and embryogenesis in general. The purpose of the study was the histological and immunohistochemical features of the transformation of the endometrium in recurrent miscarriage. It were studied 100 samples of endometrium in case of non-developing pregnancy at a development period of 5-8 weeks, 85 samples in habitual miscarriage and 15 samples in pregnancy interrupted surgically at the request of the woman. The presence of 2 non-developing pregnancies was verified in 57 cases (67,1%), the presence of 3 non-developing pregnancies in 28 cases (32,9%). A histological examination of the abortion material stained with hematoxylin and eosin was performed to verify the morphological transformation of the endometrium. Immunohistochemical study included detection of estrogen and progesterone receptors, stromal cell factor (SDF1), progesterone-induced blocking factor (PIBF). The results of histological and immunohistochemical studies showed that with a complete morphological transformation of the endometrium in the group of patients with habitual miscarriage, there is a violation of the receptor profile. The decrease in PIBF expression in the glands and the stromal component and the expression of SDF1 in the glands of the compact layer of the endometrium is a reflection of the immunological imbalance in the endometrium in recurrent miscarriage. The development of a unified morphological algorithm, taking into account the basic indicators of the processes of transformation of the endometrium with an assessment of its receptor profile and diagnostically significant immunological factors, makes it possible to verify the pathology of the endometrium at the molecular level and justify the need for using pathogenetically substantiated therapy at recurrent miscarriage.
The problems of pathological diagnosis of recurrent miscarriage are relevant in modern reproductive medicine. One of the important molecular markers of endometrium is the progesterone-induced blocking factor, which is induced by progesterone under the influence of activated lymphocytes and has an immunomodulatory effect on the implantation characteristics of the endometrium. In the process of trophoblast invasion, a special role is also played stromal cell factor molecules synthesized by endometrial and trophoblast cells, as a mechanism that potentiates the susceptibility of the endometrium to the onset and development of pregnancy, trophoblast invasion and embryogenesis in general. The purpose of the study was the histological and immunohistochemical features of the transformation of the endometrium in recurrent miscarriage. It were studied 100 samples of endometrium in case of non-developing pregnancy at a development period of 5-8 weeks, 85 samples in habitual miscarriage and 15 samples in pregnancy interrupted surgically at the request of the woman. The presence of 2 non-developing pregnancies was verified in 57 cases (67,1%), the presence of 3 non-developing pregnancies in 28 cases (32,9%). A histological examination of the abortion material stained with hematoxylin and eosin was performed to verify the morphological transformation of the endometrium. Immunohistochemical study included detection of estrogen and progesterone receptors, stromal cell factor (SDF1), progesterone-induced blocking factor (PIBF). The results of histological and immunohistochemical studies showed that with a complete morphological transformation of the endometrium in the group of patients with habitual miscarriage, there is a violation of the receptor profile. The decrease in PIBF expression in the glands and the stromal component and the expression of SDF1 in the glands of the compact layer of the endometrium is a reflection of the immunological imbalance in the endometrium in recurrent miscarriage. The development of a unified morphological algorithm, taking into account the basic indicators of the processes of transformation of the endometrium with an assessment of its receptor profile and diagnostically significant immunological factors, makes it possible to verify the pathology of the endometrium at the molecular level and justify the need for using pathogenetically substantiated therapy at recurrent miscarriage.
Introduction Chronic endometritis is one of the most important factors leading to reduced fertility in women. The protracted discussion about the presence of this nosology in clinical practice for more than 100 years does not allow to establish the true frequency of chronic endometritis in women of reproductive age. At the present stage, due to the unfavorable demographic situation both in the Russian Federation and in many countries, the study of chronic endometritis, as one of the main determinants of the lesions of the morphological and functional state of the endometrium, is relevant.The purpose of the study is to determine the current state of the problem of verification of chronic endometritis in women with infertility, reproductive losses and repeated failure of assisted reproductive technologies (ART).Materials and methods The sources of information were publications from the databases PubMed, Google Scholar, elibrary.ru and Russian medical journals in the field of obstetrics and gynecology, as well as pathological anatomy in the period from 2013 to 2022.Results and discussion An analysis of the literature showed that chronic endometritis is the cause of infertility, miscarriage and ineffective ART protocols and leads to decrease of the regenerative potential and endometrial reserve. Despite the evidence of the negative impact of chronic endometritis on the reproductive function, at the present stage, the discussion regarding diagnostic approaches to this nosology continues. The use of the histological method of research, as the main and available method for diagnosing the state of the endometrium, is not always allow to verify chronic endometritis, which dictates the need of using high technological methods to confirm and clarify the severity of the pathological process.Conclusion A unified algorithm for diagnosing chronic endometritis in patients with infertility, miscarriage, ineffective ART cycles and a qualified approach to the morphological diagnosis of the state of the endometrium, standardization of the diagnosis of chronic endometritis, and competent interpretation of immunohistochemical data make it possible to select a pathogenetically substantiated therapy aimed at the rehabilitation of reproductive function.
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