Aspects of Local Immunoregulation in Women after Missed Miscarriage in Anamnesis

Pregnancy with a favorable outcome is a unique immunological phenomenon, suggesting, in particular, a shift in the balance of effector T helper lymphocytes CD4 +, known as Th1 and Th2, and a predominance of the Th2 subpopulation. According to the literature, limitations of the "classical" Th1 / Th2 paradigm were shown. The features of the immune status of women with a missed miscarriage are considered mainly in the context of concomitant genital and extragenital infections, and individual immunological indicators are used as markers or predictors of complications of pregnancy, without pathogenetic significance of the detected immune disorders. This review is devoted to characterization of differentiation factors, key cytokines and transcription factors, as well as the role of Th1 and Th2 cells in the immunoregulatory interaction of mother and fetus organisms in physiological and missed miscarriage, discussing the balance of CD4 + helper T lymphocytes attributed to Th1, Th2 subpopulations, and regulators T-lymphocytes in physiological pregnancy and the study of violations of this balance. These subpopulations of T cells realize the main variants of the adaptive immune response, differ in the spectrum of cytokines. The purpose of this study was to investigate immunological tolerance at a local level in women with physiological pregnancy and missed miscarriage. Materials and methods.142 patients aged 18 to 35 years were examined by us, who were divided into two groups: 52 patients presented missed miscarriage in the period from 4 to 8 weeks of gestation (the main group) and 45 women presented an artificial abortion (the comparison group) and 45 patients included full luteal phase (control group). The conducted studies showed that the patients of the main group in the case history had a high incidence of inflammatory gynecological diseases, as well as reproductive disorders, spontaneous abortions and undeveloped pregnancies. For the rest of the indicators, all the groups were representative. Using a morphological study, it was possible to verify the diagnosis of chronic inflammation in the endometrium and confirm the death of the fetal egg, as well as to identify the presence of a bacterial-viral associate persistent in the uterine cavity. Conclusions. Obviously, with the progression of pregnancy and gestational complications, an important role is not the increase or decrease of certain interleukins, but their interrelation and quantitative relationships of the entire cytokine cascade, especially those occurring at the local level. Interrelation and interrelations of interleukins in the cytokine cascade affect the development of the gestational process and, most likely, is a consequence of changes occurring in chronic inflammation of the endometrium. Prospects for further research. The entire complex of the cytokine cascade is closely related to hormonal changes in the body of a woman. The influence of hormones on the endometrium, even before the onset of implantation, forms the direction of a local cytokine immune response. From this it is clear that along with ongoing antibiotic and antiviral treatment, restoration and hormonal imbalance should be carried out.