HISTOLOGICAL FEATURES OF THE INFECTIOUS AND INFLAMMATORY STATE OF THE PLACENTA IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES DEPENDING ON THE DURATION OF THE INTERVAL BETWEEN MEMBRANE RAPTURE AND DELIVERY AND OTHER FACTORS

Abstract

The purpose of the study is to evaluate the histological features of the placenta in women with pregnancy complicated by preterm premature rupture of membranes (pPROM) and their relationship with the duration of the interval between membrane rapture and delivery, the level of expression of antimicrobial peptides (β-2-defensins) and other factors of pregnancy and labour. Methods. We examined 56 women of the main group, whose pregnancy was complicated by pPROM at 23-36 weeks of pregnancy and 20 pregnant women of the control group with intact fetal membranes, who subsequently gave birth to full-term babies. The study included anamnesis, study of the course of pregnancy, labour and postpartum period, clinical and laboratory parameters of the mother, including the level of expression of antimicrobial peptides (ß-2-defensins) in the blood serum, functional status of the newborn, histological examination of the placenta. In the histological examination of the placenta, signs of infection and inflammation, placental insufficiency, the presence of compensatory and adaptive reactions were determined. Results. The course of pregnancy, complicated by pPROM, caused a high incidence of perinatal losses. No significant relationship between the condition of newborns and the duration of the interval between membrane rapture and delivery was found; the indicators generally corresponded to the estimates characteristic of premature infants and correlated with the gestational age of the child. Analysis of the localization of infectious and inflammatory changes in the placentas of women with pPROM showed a high incidence of membranous lesions, as evidenced by the detection of signs of purulent necrotic membranitis in more than half of the observations (57.1%), especially with an increase in the duration of the interval between membrane rapture and delivery (more than 70% of cases). Conclusions. It was found that the morphological examination of placentas in women with pregnancy complicated by pPROM in most cases (85.7%) revealed signs of placental insufficiency, of which in a quarter of cases (25.0%) the insufficiency had an acute course, which was closely associated with perinatal mortality. The frequency of lesions of various elements and structures of the placenta, membranes and umbilical cord of infectious and inflammatory nature significantly depended on the duration of the interval between membrane rapture and delivery. The average level of expression of ß-2-defensins in the blood of pregnant women with pPROM was reduced by 1.4 times compared to healthy pregnant women and inversely correlated with both the acute course of placental insufficiency and funiculitis and combined damage to several elements and structures of the placenta.

Keywords

• preterm premature rupture of membranes,histological examination of the placenta,interval between membrane rapture and delivery,expression of beta-2-defensins.