New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.59.40-44

Keywords:

miscarriage, pregravid period, gestation period, matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases, diseases of the hepatobiliary system, hepatic steatosis, non-alcoholic steatohepatitis

Abstract

Study objective: to determine the dynamics of type 9 metalloproteinase (MMP-9) and its tissue inhibitor-1 (TIMP-1) in the pathogenesis of early miscarriage in women with chronic diseases of the hepatobiliary system.
Materials and methods. The study included 39 women with a history of early pregnancy miscarriage, who were diagnosed with chronic liver diseases as a result of clinical, instrumental and laboratory studies (17 persons with steatosis and 22 persons with non-alcoholic steatohepatitis). The control group consisted of 8 women without somatic pathology and 8 pregnant women at the first trimester of gestation. MMP-9 and TIMP-1 value in the blood serum was determined by the enzyme immunoassay.
Results. MMP-9 and TIMP-1 growth in the blood serum of women with a history of miscarriage was established in the pre-gravidar period. The most significant increase in the parameters of the intercellular matrix was found in patients with non-alcoholic steatohepatitis. MMP-9 and TIMP-1 increased in in blood serum in the first trimester in women with liver diseases. MMP-9 increased against the background of a decrease in the TIMP-1 activity in patients with the threat of premature pregnancy termination. Miscarriage was diagnosed in patients with a minimum value of a tissue inhibitor.
Conclusions. There is an imbalance between MMP-9 and TIMP-1 in the blood serum in women with early miscarriage and chronic diseases of the hepatobiliary system. MMP-9 and TIMP-1 level in patients with hepatic steatosis is lower than in patients with non-alcoholic steatohepatitis. MMP-9 increased during physiological pregnancy, and the TIMP-1 activity practically did not change, which indicates the role of MMP-9 in the initial stages of placentation. MMP-9 value in women with a burdened premorbid background with a physiological course of pregnancy and threatening early spontaneous miscarriage was significantly different. The highest activity of MMP-9 was in women with the threat of spontaneous miscarriage in the early stages. TIMP-1 in the first trimester in women with chronic liver disease increased in those with a favorable course of pregnancy and decreased in the threat of spontaneous miscarriage. Such changes in MMP-9 and TIMP-1 in patients with miscarriage indicate the accumulation of intercellular matrix and sclerotic changes in the vessels that provide blood to the uterus.

Author Biographies

I.V. Loskutova, Lugansk State Medical University, Rubizhne

MD, professor, head of the Department of Intensive Care, Emergency and Anesthesiology

R.G. Bichevska, Maternity Hospital No. 7, Odesa

PhD, obstetrician gynecologist, Department of Pathology of Pregnant Women

N.G. Korniiets, Lugansk State Medical University, Rubizhne

PhD, associate professor, head of the Department of Obstetrics and Gynecology

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Published

2021-07-22

Issue

Section

Pregnancy and childbirth