Results of the morphological and immunohistochemical study of the consequences in premature birth and premature rupture of the membrane

Abstract

The article presents the results of a morphological and immunohistochemical study of the afterbirths of women with miscarriages in cases of premature rupture of membranes (PRPO).The aim: to study the morphological and immunohistochemical features of placentas in premature births and premature rupture of membranes and to conduct a comparative analysis of the results depending on the gestational period.Material and methods. A morphological and immunohistochemical study of the litters of 250 pregnant women (the main group) with spontaneous premature births at 22-36 weeks of gestation and premature rupture of the membranes, which took place on the basis of the Department for Pregnant Women with Obstetric Pathology of the PAG Institute named after Acad. OHM. Lukyanova National Academy of Sciences of Ukraine" for the period from 2018 to 2020. The women of the main group are divided into three groups depending on the date of delivery - the 1st group includes patients who gave birth at 22-28 weeks of pregnancy, patients of the 2nd group who gave birth at 29-33 weeks, and to the 3rd group - those who gave birth at 34-36 weeks of pregnancy. Placentas of pregnant women of the main group were examined using morphological (histological method - staining with hematoxylin and eosin and van Gieson) and immunohistochemical methods (indirect streptavidin-peroxidase method for determining the expression level of progesterone receptors - RP).Results and discussion. Premature maturation of chorionic villi was found in 40 % of placentas of women in the 1st group 1, in 20 % – blood circulation disorders and the presence of acute inflammatory infiltration in the fetal membranes, decidual and chorionic membranes, 10 % – pathological immaturity of the placenta according to the variant of chaotic sclerosed villi. During the immunohistochemical study of RP, an unexpressed reaction was found in the epithelium and stromal cells of the stem, intermediate and terminal villi – 1 point; in fetal membranes and extra-villous cytotrophoblast – 2 points; in the endothelium of vessels – 0–1 point. In the placentas of women in the 2nd and 3nd group premature maturation of villi was found in 70 % of cases, pseudo-infarcts of villi which are embedded in fibrinoid occupying a significant area – 45 %, afunctional zones – 55 %, blood circulation disorders – 35 %, pathological immaturity placenta according to the variant of chaotic, sclerosed villi – 20 %, acute inflammatory infiltration in the fetal membranes – 15 %. Immunohistochemical analysis of the placental barrier revealed the highest expression of RP in the nuclei of decidual cell which belong to the maternal structure. Of note is the presence of progesterone receptor expression in stem villi, fibroblasts, and vessel wall nuclei. Minimal or absent expression was determined in the nuclei of other villous structures and their vessels. Conclusions. It has been proven that the receptivity of progesterone has its own characteristics in placental structures depending on the gestation period, which is an important factor in the choice of management for the prevention and reduction of perinatal losses for this contingent of pregnant women. The conducted studies make it possible to formulate a clear concept of pathogenetically justified therapy for miscarriage.