The influence of infections and immune disorders on the development of intra-uterine pathology in women with antenatal fetal death in the anamnesis

Reproductive losses remain an urgent problem among the female population, of which antenatal fetal death (AFD) takes a leading place. The pathogenesis of this pathology is multifactorial, but at the same time, it is impossible to accurately determine the single cause of AFD.Analyzing the frequency of AFD in the world, a tendency towards repeated episodes of AFD or AFD combined with reproductive losses in early pregnancy has been established. The literature has presented data on causal relationships with existing endometrial pathology, among which the inflammatory process in the endometrium takes the leading position, and pregnancy losses with inadequate immune system response.The objective: to determine the state of the immune system, infectious profile and features of the immunohistochemical state of the endometrium in women with a history of AFD at the stage of prepregnancy preparation.Materials and methods. A clinical examination was performed on 30 patients with a history of AFD who had applied to the antenatal clinic of the municipal non-profit enterprise “Kyiv City Maternity Hospital No. 3” regarding planning their next pregnancy. A general clinical examination, a detailed analysis of the general, gynecological anamnesis, and data on the course of the previous pregnancy and childbirth were performed.All patients underwent microscopic examination of vaginal discharge stained with Gram and assessed according to the Hay–Ison criteria. The state of the endometrium was studied by microscopic examination and immunohistochemical analysis with the determination of CD-138 and CD-56. The state of the immune system was assessed by determining the activity of the cellular component (T- and B-lymphocytes) and cytokine proteins (IL-1α, IL-6, IL-8, γ-INT, TNF-α).Results. According to the somatic anamnesis, a high percentage of morbidity of the urinary system of an infectious-inflammatory nature (53.3%) and pathology of the cardiovascular system (63.3%) was determined. Among gynecological pathology inflammatory diseases of the genital tract (53.3%) and uterine leiomyoma (33.3%) predominated. In the obstetric anamnesis the spontaneous miscarriage was detected in almost every second woman (46.7%) and in every seventh woman – AFD (13.3%).During microscopic examination of vaginal discharge, the majority of women were diagnosed with stage III and IV according to the Hay–Ison criteria. During microscopic examination of the endometrium, disorders of its proliferation was detected in 2/3 of the patients, and during immunohistochemical examination – a positive reaction of CD-138 and an increased concentration of CD-56. During the study of the state of the immune system a decreased level of T-suppressors, B-lymphocytes were observed, with increased in T-killers and pro-inflammatory cytokines.Conclusions. Women with a history of antenatal fetal death have certain features of the regulatory mechanisms of the immune system both at the local and generalized levels, which prompts a detailed study and diagnosis at the pre-gravid stage when determining further reproductive plans. Research of extragenital pathology, infectious profile and the state of local immunity in the uterine cavity is especially necessary.