Immune and immunohistochemical profile in women with miscarriage: modern approaches and research data

Relevance. Miscarriage is a serious problem, affecting up to 15–20% of all pregnancies. Women with a previous miscarriage have a significantly higher risk of recurrent miscarriage, making predicting pregnancy outcomes an extremely important aspect to minimize complications. This article presents modern forecasting methods based on our own research data. Purpose of the work. To study the hormonal and immunological characteristics of the blood, the immunohistochemical characteristics of the endometrial decidua, to identify the mechanisms of the causes of miscarriage in early pregnancy. Study design. Open independent prospective study. Material and methods. To achieve this goal, a retrospective analysis of 382 patient records was carried out. A comparative prospective controlled study was performed in 258 women with recurrent miscarriage. The first group included 198 women with recurrent miscarriage. The control group consisted of 60 healthy fertile women who had no history of miscarriages, with a history of full-term birth through the birth canal, without deviations from the physiological course of pregnancy and the act of birth, which resulted in the birth of healthy children. At the second stage of the study, the main group was divided into two subgroups: Group 1 (n=100): formed from patients who subsequently received a personalized, comprehensive examination and prenatal preparation, Group II (n=98) – from patients who subsequently received the generally accepted scope of diagnosis and treatment. Results. One of the signs that attracted us was an increase in body temperature above 37.2 degrees in women of the main group during pregnancy, which was significantly different from the control group (p≤0.001). And the most interesting thing is that during intrauterine fetal death, the body temperature dropped automatically. In addition, from the hematological study indicators, a tendency was identified towards an increase in the absolute number of leukocytes in women of group 1 during developing pregnancy, as fetal death or spontaneous miscarriage occurred, leukocytes began to decrease. It should be noted that when assessing the biochemical parameters of pregnant women in the main group, a statistically significant increase in the reference values of ALT and AST was established. When determining antibodies to human chorionic gonadotropin in the blood, an increase in antibodies was detected in the first group, which was significantly different from the control group (p≤0.001). Intragroup correlation analysis in uncomplicated pregnancy showed a significant (p<0.05) highly positive correlation between the Ki67 indicator, responsible for proliferation of the endometrial stroma, and the size of differentiating stromal cells in women of the control group. The decidual index of the main group of estrogen receptors in the membrane is reduced by 2.1 times when expressed. The membrane level of progesterone in cells 3 and 11, respectively, compared with uncomplicated pregnancies, in decidual receptors of immune expression is reduced by 3 times. Conclusion. A successful pregnancy requires the correct interaction between individual hormones and their corresponding receptors. Dysregulation or inadequate expression in one of these three compartments can lead to implantation failure or pregnancy loss.