Prophylaxis of decidual CD68+/CD163+ macrophage disbalance in extracorporeal fertilized women.

The demographic crisis that prevailed in Ukraine in recent years, the state of war as a result of the aggression of the Russian Federation, reproductive losses among women of childbearing age are one of the most urgent problems in modern obstetrics and gynecology. One of the most effective methods of correcting impaired reproductive function is in vitro fertilization. The purpose of this work: is to develop a pharmacological complex for the prevention of imbalance of CD68+/CD163+ decidual macrophages in vitro fertilized women. Materials and methods: 105 pregnant women who were divided into 3 groups took part in the study. The first group included 20 women whose pregnancy occurred and is proceeding physiologically. The second group consisted of 85 women who became pregnant as a result of in vitro fertilization, including 37 pregnant women who refused prophylactic correction of the threat of premature birth, and 48 pregnant women who received prophylactic correction of the threat of premature birth: complex prescription of vitamin D3 2000 IU orally 2 times a day, micronized progesterone 200 mg 2 times a day and l-arginine aspartate 1000 mg 4 times a day, starting from 18 to 20 weeks of pregnancy. Results: In women who refused prophylactic correction of the threat of premature birth, a local increase in the activity of inducible NO-synthase and concentration of tumor necrosis factor-α, and a decrease in the activity of arginase and in the level of interleukin-10 were observed in the cervical mucus. They have a lower expression of CD163+ on placental decidual macrophages and an increased expression of CD68+, which indicates a shift in the polarization of macrophages from an anti-inflammatory to a pro-inflammatory phenotype. The use of prophylactic treatment brings the studied parameters closer to the results of women in whom pregnancy occurred physiologically. Conclusions: In women who became pregnant as a result of in vitro fertilization, at 28-30 weeks of pregnancy, changes specific for pro-inflammatory phenotype of decidual macrophages were observed. Complex administration of vitamin D3, micronized progesterone and l-arginine aspartate lead to restoration of anti-inflammatory phenotype of decidual macrophages.

IMPACT OF PREVENTIVE THERAPY ON REGULATING MECHANISMS OF DECIDUAL MACROPHAGE POLARIZATION IN PREGNANT WOMEN WITH HIGH RISK OF PREECLAMPLSIA.

OBJECTIVE: The aim: This study was aimed at analyzing the impact of preventive therapy for pregnant women at a high risk to develop preeclampsia on the normalization of the mechanisms of decidual macrophage polarization. PATIENTS AND METHODS: Materials and methods: The methodology was designed to obtain data on the content of pro- and anti-inflammatory cytokines and indicators of nitric oxide and arginase metabolism in cervical mucus. The ration between M1 / M2 decidual macrophages in the placenta was determined by applying immunohistochemical methods. The effectiveness of the proposed therapy for the secondary prevention of preeclampsia (metformin, vitamin D3 and corvitin) was evaluated. RESULTS: Results: Pregnant women with preeclampsia showed the imbalance between pro- and anti-inflammatory cytokines in favour of TNF-α and INF-γ under the decrease in IL-10 that results in an imbalance in the activity of enzymes regulating L-arginine metabolism, with increased iNOS activity and decreased arginine activity. In the placentas of the pregnant women with preeclampsia, in contrast to the healthy pregnant women, M1 decidual macrophages are found as predominant. The women, who received the course of the preventive therapy with metformin, vitamin D3 and corvitin, showed a decrease in the concentration of pro-inflammatory cytokines and an increase in anti-inflammatory cytokine IL-10, normalization of the balance between iNOS and arginase activity, and the normalization of the M1 / M2 macrophages ratio. CONCLUSION: Conclusions: Normalization of the balance between pro- and anti-inflammatory cytokines, iNOS and arginase activity in cervical mucus, the ratio between decidual M1 and M2 macrophages as results of the therapy proposed reduce the incidence of preeclampsia and associated complications.

Changes of psycho-emotional state in the infertile pregnant females due to the anamnesis and IVF.

OBJECTIVE: Introduction: During pregnancy in the body of a healthy woman there are physiological and psychological changes that contribute to the bearing a child and prepare the female for future labour and motherhood. In women who experience failure at the stage of fertilization or during pregnancy, as a result of prolonged negative emotional states, psycho-emotional stress develops. The aim of the research was to study the psycho-emotional state of women with infertility in history, whose pregnancy resulted from extracorporal fertilization (IVF), and to develop methods for reducing their anxiety. PATIENTS AND METHODS: Materials and methods: At the first stage, the initial psycho-emotional state of 60 women in the second trimester, whose pregnancy resulted from IVF (Group I), was studied; the control group consisted of 20 healthy women with a physiological course of pregnancy (Group II). At the second stage, 10 art therapy exercises with a requestioning of pregnant women from Group I were conducted for improving their psycho-emotional state. RESULTS: Results: Women of Group I had a high level of both situational anxiety (SA) and the personal one (PA). The prevalent type of the psychological component of gestational dominant was anxiety and euphoric types (58.3%). In one third of women with burdened gynecological history examined mild or masked depression was diagnosed. 43 pregnant women from Group I used a method of psychocorrection - art therapy, which included colouring "antistress" pictures of perinatal topic, making flowers from paper and creating a collage of dreams. CONCLUSION: Conclusions: After the art therapy course, a high level of SA (from 46.5% to 7.0%) and OA (from 48.8% to 32.6%) decreased, the index of the optimal type of the psychological component of gestational dominant increased from 25.6% to 53.5%. The number of women without depression increased from 62.8% to 93%.