IMMUNOHISTOCHEMICAL EVALUATION OF VON WILLEBRAND FACTOR IN ENDOTELIUM OF MYOMETRIAL VESSELS IN THE PROJECTION OF UTEROPLACENTAL BED DURING THE IRON DEFICIENCY ANEMIA IN PREGNANCY

Abstract

Iron deficiency anemia in pregnancy (IDAP) is one of the most pressing problems ofmodern obstetrics, its frequency in different regions varies in a wide range of 28 –85%. Pregnant women with iron deficiency anemia undergo gestational immaturityin utero-placental bed due to insufficiency of cytotrophoblastic invasion. It is knownthat defective gestational rearrangement of the utero-placental arteries, especiallytheir myometrial segments, is the morphological basis for increasing pressure inthe intervillous space. Immunohistochemical technique for von Willebrand factor inutero-placental bed and myometrium allows to assess the processes of angiogenesisand vasculogenesis, endothelial dysfunction, early and late thrombosis, features of thegestational reorganization of spiral arteries in utero-placental bed.Purpose of the work: to determine the features of von Willebrand factor immunoexpressionin the endothelium of myometrial vessels in the projection of the utero-placental bed iniron deficiency anemia in pregnancy at 37 – 40 weeks of gestation.Material and methods. 58 biopsies of utero-placental bed and myometrium weremorphologically studied after being obtained during caesarean section, observations ofphysiological pregnancy and gestation in conditions of the I - II degree IDAP withoutclinical signs of placental insufficiency. On histological sections were performed: 1)immunohistochemical method for von Willebrand factor; 2) histochemical method forfibrin and collagen fibers by NZ Slinchenko; 3) staining with hematoxylin and eosin.Results. Observations of myometrial biopsies in the projection of utero-placental bedduring pregnancy against a background of IDAP showed a significant increase in theintensity of staining of endotheliocytes of all vessel types: in arteries of women with IDAP of the I degree optical density of staining was 0.451±0.0024 ODU, in conditionsof the II degree IDAP – 0,458±0.0022 ODU; in venous vessels in IDAP of the Idegree optical density was 0,393±0,0026 ODU, in veins of women with IDAP of theII degree – 0,405±0,0022 ODU; in vessels of microcirculation in IDAP of the I degreeimmunoexpression of von Willebrand factor was 0,394±0,0022 ODU, and during IDAPof the II degree – 0,398±0,0025 ODU.Conclusions. During pregnancy against a background of iron deficiency anemia,the utero-placental bed and myometrium have morphological signs of gestationalimmaturity. The growth of von Willebrand factor immunoexpression in endothelialcells, the manifestation of enhanced endothelial cell desquamation and thrombosis atdifferent stages, detected in different types of myometrial vessels, should be regardedas prerequisites for hypoperfusion of utero-placental bed and the development of thedisorders of venous outflow from the placental bed in the uterus.