The role of endotheliopathy in the pathogenesis of missed miscarriage

Abstract

The purpose of our study was determination of the endothelial dysfunction in volvement in the pathogenesis of non-developing pregnancy. Methods. The study used the cytomorphometric method for diagnostics of endothelial dysfunction to assess the degree of destruction of endothelial cells by non-developing pregnancy. The study based on the results of examination of 180 pregnant women. For the purpose of estimating the state of the endothelium, the determination of concentration of desquamated endothelial cells in the peripheral blood was used.
The cytometry of fixed drugs of desquamated endothelial cells using the developed techniques was carried out with the aim to determine the apoptotic activity in the studied cells. To estimate endothelium state in the fetus, morphometry of the chorion vessels obtained by curettage of uterine cavity was performed. As the material of studies, the chorion scrapings at 7—10 weeks of pregnancy were used. Set of techniques studied 180 chorion samples obtained by curettage of uterine cavity of the examined women. Results. The cytometric characteristics of endotheliocytes showed significant differences in groups by the development of endothelial dysfunction: the average diameter of endotheliocyte and the average perimeter of endotheliocyte was a reliable difference in 1.5 times lower in the intervention group (p<0.001, t = 6,67). Computerized morphometry of the chorion vessels, the average thickness of a primary vessel containing only endothelial cells made up 1.28 ± 0,37 mm in the group with miscarriage and 3.75 ± 0.63 mm in the control group (p<0.001, t = 3,36). Kernohan Index also had significant differences in the studied groups: 0.041 in the main group and 0.115 in the control (p<0.001, t = 5,9). Conclusion. The development of endothelial dysfunction of pregnant women is accompanied by reliable changes of the endothelium of the chorion which is confirmed by the statistical validity of our study. Endothelial injury recorded for pregnant women in the first trimester is accompanied by disturbance of the endothelial walls of blood vessels of the chorion which leads to impaired development of the pregnancy and its termination.