New aspects of the pathogenesis of placental insufficiency

Abstract

Relevance. Placental insufficiency is a polycausal syndrome characterized by a violation of the molecular, cellular, tissue and organ adaptivehomeostatic reactions of the fetoplacental system. The active participation of the neutrophil component of the innate immune system in the development of endothelial dysfunction and thrombotic disorders, which underlie many complications of pregnancy, has been proven, which served as the reason for conducting exploratory studies to assess the level of neutrophil extracellular traps (NETs) in pregnant women at different stages of gestation.The purpose of the study is to identify the features of the formation of neutrophil extracellular traps in pregnant women with normal pregnancy and placental insufficiency associated with thrombophiliaMaterial and methods. 85 pregnant women in the second and third trimester were examined: 40 women with normal pregnancy (comparison group) and 45 (main group) with thrombophilia (protein S/protein C deficiency) and subcompensated placental insufficiency. The level of NVL was assessed in blood smears according to the monolayer type using an automatic microscopic system MECOS-C 2.Results. It was found that the level of DNA traps in normal pregnancy and in pregnant women with placental insufficiency at 21–24 weeks of gestation was 1.3 and almost 2 times higher than the level outside pregnancy (p <0.05), with a predominance of phase IIa etosis. By 36–37 weeks, in a normal pregnancy, there was a slight increase in%NVL (16 %), while in the group of pregnant women with placental insufficiency,%NVL increased by 35.7 % compared to the initial data, maintaining a high content of extracellular structures in IIa phase of ethotic transformation (7.4 % versus 5.8 % at 21–24 weeks, p >0.05).Conclusion. It is obvious that the presence of a high level of NIV indicates a failure of immune defense mechanisms and the development of an inadequate inflammatory response in the pathogenesis of fetoplacental insufficiency, which can be useful when carrying out intermediate dynamic monitoring of the condition of a pregnant woman.