Morphological Features of the Endometrium Transformation in Recurrent Miscarriage

Abstract

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.