Клініко-патогенетичні аспекти формування ендотеліальної дисфункції у вагітних з хронічним ендометритом в анамнезі

Abstract

Досліджені концентрація оксиду азоту та десквамованих ендотеліоцитів впродовж вагітності у 135 жінок з хронічним ендометритом (ХЕ) в анамнезі, які до вагітності отримали лікування, та у 168 вагітних, які від нього відмовилися. Результати свідчать, що у жінок, вагітність яких наступила на фоні ХЕ, в 6-8 тижнів кількість десквамованих ендотеліоцитів на 75% перевищує контрольні показники. Це створює передумови для формування гестаційної ендотеліопатії та прееклампсії. Проведення преконцепційного лікування ХЕ дає змогу профілактувати виникнення прееклампсії, особливо тяжких її форм, та збільшує терміни її клінічної маніфестації.

The condition of the endometrium and the histological changes associated with chronic endometritis (CE) at pregnancy may be important in the formation of gestational endotheliopathy and associated preeclampsia. The aim of the research: to determine the peculiarities of the formation of gestational endotheliopathy in women whose pregnancy occurred against the background of CE and to determine the effectiveness of pre-conceptual treatment of CE in the prevention of preeclampsia. Object and methods of the research: a total of 303 women with a history of pregnancy were monitored during pregnancy, of whom 135 women received comprehensive treatment for CE (group I) at the stage of pregnancy planning. Treatment included antibacterial, anti-inflammatory and hormonal agents. The other 168 pregnant women of the mail group refused the treatment of CE in the pre-conceptual period (group II), which was documented in writing. The control group consisted of 20 healthy pregnant women with unremarkable medical history. The study included the determination of total nitrate and nitrite counts and the calculation of desquamated endothelial cells in the blood and was performed at 6-8, 16-18, and 32-34 weeks of gestation. Results. In women whose pregnancy occurred against the background of CE, at the beginning of gestation (6-8 weeks) the number of desquamated endothelial cells in the blood exceeds the control indicators by 75%; the concentration of total nitrates and nitrites at this time is not significantly different from the control values. This indicates a predominance of desquamation processes in vascular endothelium in women with CE in anamnesis. In such women, 32.1% of pregnancies were complicated by the onset of preeclampsia, with one-third being severe. In pregnant women with CE in anamnesis, the development of pre-eclampsia with moderate manifestations causes the increase of nitric oxide in the third trimester of pregnancy which is not consistent with control indicators (by 20% less), and in the case of severe preeclampsia, it critically decreases (by 46.7% less than the control indicators). This probably indicates the inability of the mechanisms of vasodilator synthesis to compensate for the increasing endotheliosis and causes the severity of clinical manifestation of preeclampsia. In women, who underwent treatment of CE in the pre-conception period, the amount of desquamated endothelial cells in the blood at 6-8 weeks of gestation is 64% less than in the untreated patients, and it corresponds to controls in healthy women. The incidence of preeclampsia is 17%, and it was severe in only 15% of these cases. The mean time at which preeclampsia occurred was 32.3 ± 0.4 weeks versus 29.4 ± 0.6 weeks in the group where women did not receive treatment for CE. Conclusions. In women whose pregnancy has occurred against the background of untreated chronic endometritis, the early stages of the gestational process create the preconditions for the formation of endotheliopathy and preeclampsia associated with it. The conducted treatment of CE for women, who are planning pregnancy, enables prevention of pre-eclampsia, especially its severe forms, at the pre-conceptual stage, and increases the duration of its clinical manifestation.