The role of the endometrium in the pathogenesis of pregnancy loss: immunohistochemical and clinical aspects

One of the key problems of modern medicine in the world is miscarriage in the early stages, which can be caused by many factors. In recent years, there has been a growing interest in this problem, which is associated with the development of new technologies that allow more accurately identifying the causes and revising the mechanisms of pathogenesis of frequent miscarriages. This article presents modern forecasting methods based on our own research data. Aim. To characterize the immunohistochemical aspects of the endometrium, as well as to determine the relationship between immunological processes, vascular and hormonal disorders in the formation of habitual miscarriage in women living in the Aral Sea zone for the development of diagnostic methods and pregravid preparation. Study design: an open independent prospective study. Material and methods. To achieve this goal, a retrospective analysis of 382 patient histories was conducted. A comparative prospective controlled study was performed in 258 women with habitual miscarriage. The first group included 198 women with habitual miscarriage. The control group consisted of 60 healthy fertile women with no history of miscarriages. Results. When determining antibodies to chorionic gonadotropin in the blood, an increase in antibodies was found in the first group, which was significantly different from the control (p≤0.001). Intragroup correlation analysis in uncomplicated pregnancy showed a reliable (p<0.05) highly positive correlation between the Ki-67 index responsible for the proliferation of the endometrial stroma and the sizes of differentiating stromal cells in women in the control group. The decidual index of the main group of estrogen receptors in the membrane during expression is reduced by 2.1 times. 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. 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 unsuccessful implantation or pregnancy loss.