Inflammatory changes in the placenta in ischemic-cervical insufficiency

Abstract

Introduction. The high frequency of inflammatory changin the placenta in isthmic-cervical insufficiency may be primarily associated with an ascending infection as a result of a violation of the barrier function of the cervix, however, premature remodeling of the cervix may also be secondary due to an already existing process. The study of the features of the spread of the infectious process and thnature of the inflammatory reaction in various structures of the placenta and fetal membranes can contribute to the understanding of pathogenetic mechanisms of preterm birth in isthmic-crvical insufficiency. Aim of the study — to evaluate the frequency and structure of inflammatory changes in the placenta in women with isthmic-cervical insufficiency. Materials and methods. A prospective cohort study was conduct, which included 154 pregnant women taken by the continuous sampling method. All patients were divided into two groups: group 1 consisted of 100 pregnant women with isthmic-cervical insufficiency, group 2 — pregnant women without isthmic-cervical insufficiency. All women after childbirth underwent a pathomorphological examination of the afterbirth. Results and discussion. In women with isthmic-cervical insufficiency, inflamatory changes in the placenta were detected in 71% (71) of cases, which was significantly more frequent compared to group 2 — 38.9% (21). Membranitis was significantly more frequent in isthmic-cervical insufficiency, amounting to 16% (16) versus 3.7% (2) comparison group (OR=4.32, 95% СI=1.03-18.09, p=0.023). Chorioamnionitis was 6 times more common in the afterbirth in women of group 1, accounting for 12% (12), versus 1.9% (1) in group 2 (OR=6.48, 95% CI=0.87-48.51, p=0.031). Involvement of the umbilical cord in the inflammatory process occurred only in pregnant women with isthmic-cervical insufficiency: funiculitis was combined with membranitis in 4% (4) of cases (p=0.137), the combination of funiculitis with choriomnionitis was detcted in 7% (7) of women p=0.047). Conclusion. The frequencof detection of inflammatory changes in the placenta in ICN was 71% (71). In the structure of inflammatory changes of the afterbirth in patients with ICN, the defeat of the fetal membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage to the umbilical cord in ICN can occur both wth total inflammation of all structures of the placenta, and directly through the fetal membranes, without involving the chorion in the process.