Морфологічні та імуногістохімічні особливості плацент у породіль з інфекціями, що передаються статевим шляхом, в анамнезі

Abstract

Purpose - to explore and evaluate macroscopic, histological, morphological and immunohistochemical changes in the placenta, to study the peculiarities of the marker expression of endothelial cells CD34 in the vascular bed of the placental villous tree in women in labour with a history of sexually transmitted infections (STIs) after pregravid preparation before cycles of assisted reproductive technologies (ART). Materials and methods. The analysis of morphological and immunohistochemical examination as well as expression level of CD34 in 50 placentas from women in labour with a history of STIs was conducted. The Group I (main) - 25 placentas from the women in labour who underwent pregravid preparation before the ART cycle, obstetric and perinatal support and delivery in accordance with the medical and organizational algorithms developed by us, prognostic methods and treatment and preventive regimens; the Group II - 25 placentas from the women in labour who received generally accepted prognostic and therapeutic and preventive measures. Results. Histological examination of placentas from the women of the Group I demonstrated the manifestations of compensatory processes prevailed, and there was a much lower severity of pathological changes. The placental coefficient in the women of the Group I was probably higher than in women of the Group II, accounting for 0.17 versus 0.15. There was a decrease in the branching of blood vessels, as a result of which the capillaries occupied mainly the central and paracentral position. Dystrophic and necrotic processes, with the replacement of the chorion epithelium with fibroid masses, were manifested in a small number of terminal villi which belonged to the adaptive mechanisms. The largest area of CD34 expression in the villous chorion of the placenta was observed in the Group I and was 9.49±0.47%, in the Group II it was 1.29 times lower (7.34±0.15%; p<0.01). The highest optical density of CD34 expression in the villi chorion of the placenta was observed in the women of the Group II (0.22±0.01 r.u.), which was 1.25 times higher than in patients of the Group I (0.20±0.01 r.u.; p<0.01). Conclusions. In the case of pregravid preparation before ART cycles and in the case of complex correction of maladaptive disorders in the fetoplacental complex of pregnant women with a history of STIs, all structural mechanisms of placental adaptation are included, which allow to maintain the morphometric and diffusion parameters of the villous tree at the level of stable compensation, which is the most important adaptive tool that helps to maintain fetal viability. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.