HEALTH OF WOMAN. 2020.7(153): 19-22; doi 10.15574/HW.2020.153.19
Krotik O. I.
Shupyk National Medical Academy of Postgraduate Education MH of Ukraine, Kiev

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.

REFERENCES

1. Global health sector strategy on sexually transmitted infections 2016–2021: Towards ending STIs. Geneva: WHO: 60. 2016.

2. Smith SB, Ravel J. 2017. The vaginal microbiota, host defence and reproductive physiology. J Physiol. 595(2):451-463. https://doi.org/10.1113/JP271694; PMid:27373840 PMCid:PMC5233653

3. Schuchardt L, Rupp J. 2018. Chlamydia trachomatis as the Cause of Infectious Infertility: Acute, Repetitive or Persistent Long-Term Infection? Curr Top Microbiol Immunol. 412:159-182. https://doi.org/10.1007/82_2016_15; PMid:27370345

4. Yuldasheva RZh, Zhurumbaeva SK, Ivanova YuS i dr. 2015. IPPP i reproduktivnoe zdorove (obzor literatury). Vestnik KazNMU 2.

5. Kornienko AM, Romanyuk MG, Gurzhenko YuN, Melnikov SN, Scherbak MA. 2014. Effektivnost preparata Tsiprolet A pri lechenii nespetsificheskih vospalitelnyih zabolevaniy urogenitalnoy sferyi u supruzheskih par. Seksologiya i andrologiya 3(50):94-98.

6. Kim CJ, Romero R, Chaemsaithong P, Kim JS. 2015. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am J Obstet Gynecol. 213(4 Suppl):S53-S69. https://doi.org/10.1016/j.ajog.2015.08.041; PMid:26428503 PMCid:PMC4782598

7. Uenaka M, Morizane M, Tanimura K et al. 2019. Histopathological analysis of placentas with congenital cytomegalovirus infection. Placenta 75:62-67. https://doi.org/10.1016/j.placenta.2019.01.003; PMid:30712668

8. Ander SE, Diamond MS, Coyne CB. 2019. Immune responses at the maternal-fetal interface. Sci Immunol. 4(31):eaat6114. https://doi.org/10.1126/sciimmunol.aat6114; PMid:30635356 PMCid:PMC6744611

9. Dudina OO, Haborets YuIu. 2017. Reproduktyvne zdorovia yak chynnyk fertylnosti zhinok i yakosti zdorovia narodzhuvanykh pokolin. Ekonomika i pravo okhorony zdorovia 2:28–35.

10. Makarenko MV, Govseev DA, Popovskiy AS. 2015. Rol urogenitalnoy infektsii v pregravidarnoy podgotovke zhenschin fertilnogo vozrasta. Zdorove zhenschiny 1(97):118-121.