Морфологічні особливості системи мати–плацента–плід на фоні інфекцій, що передаються статевим шляхом

Abstract

The objective: to identify morphological substrate of placental disorders in women with urogenital infections and miscarriages and spontaneous abortions, as well as women diagnosed with «sexually transmitted infections» who gave birth at term. Materials and methods. A morphological study of samples from 80 women of reproductive age was performed. Patients were divided into 4 groups. At the first stage, histological and immunofluorescent studies of abortuses were performed in two groups of women with spontaneous abortions and missed abortions. The I group consisted of samples from 20 patients with urogenital infections, the II group – samples from 20 uninfected women. At the first stage, a morphological (histological and immunofluorescent) study of abortions was performed in two groups of women with missed and spontaneous abortions. The III group consisted of samples from 20 patients with urogenital infections, the IV group (control) – 20 samples from uninfected women. The second stage involved organometric and histostereometric examination of the placenta from women diagnosed with «sexually transmitted infections» without differentiating the forms of the infectious process (main group, n=10), who gave birth at term, and women who were uninfected (control group, n=10) and also gave birth at term. Results. Morphological study of abortuses from infected patients showed that urogenital infections are characterized by pronounced inflammatory changes in the form of deciduitis (9 specimens – 45%); chorionitis (5 specimens – 25%) and syncytial endometritis (2 specimens – 10%). The morphological picture of necrobiosis was revealed in 25% of samples (5 specimens). In addition, amnionitis (6 specimens – 30%), villisitis (4 specimens – 20%) and basal deciduitis (3 specimens – 15%) were detected. In the group of uninfected women, the leading pathomorphological changes were signs of placental immaturity and changes in vascularization and sclerosis of the villi. Most of the studies of placenta and membranes from women who gave birth at term and had urogenital infection showed significant changes in the villous chorion with the involvement of villi of different calibers. There was a significant increase in the proportion of micropathology. The presence of small necrosis of villi was established in almost 1/3 of all cases, extensive areas of necrosis occurred, but there was no significant difference between two groups. There was a decrease in the volume of the chorionic epithelium compared with the control group. Conclusions. Pathomorphological changes of abortuses and placentas in women with STIs reflected the main links in the pathogenesis of infectious and inflammatory processes and were different from such changes in the absence of this pathology. In particular, urogenital infection is characterized by changes associated with inflammatory manifestations in abortuses, and in the group of uninfected women - with signs of placental immaturity and changes in vascularization and sclerosis of the villi. Histostereometry also revealed significant differences in the structure of the placentas of women of the main and control groups, in particular, a significant increase in the proportion of micropathology. Therefore, the prevention of pregnancy complications and pregravid preparation in women diagnosed with STIs is essential for preventing reproductive failures. Keywords: sexually transmitted infections (STIs), spontaneous abortion, missed abortion, placenta, histostereometry.