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УДК.618.3-06:618.14-006.04-089.888
COMPLICATIONS THAT MAY OCCUR IN PREGNANT WOMEN WITH
LEIOMYOMA
Khaydarova N.B.
nigora_haydarova@bsmi.uz
https://orcid.org/0009-0001-8039-0082 +998-91-441-82-92
Assistant of the Department of Obstetrics and Gynecology No. 1,
Bukhara State Medical Institute.
https://doi.org/10.5281/zenodo.17612010
Objective:
To evaluate the significance of immunological markers in predicting early and
late obstetric complications in pregnant women with uterine leiomyoma.
Materials and Methods
: In the course of our study, 36 pregnant women diagnosed with
uterine leiomyoma and receiving treatment at the gynecology department of the Bukhara City
Maternity Complex were examined. All patients underwent anamnesis collection, clinical-
functional assessments, and molecular-genetic investigations.
Results:
The results of the study showed that the average level of IgA in the blood serum
of women in the control group was 1.85 ± 0.12 g/L, which falls within the normal range of 1.46
to 2.22 g/L. In women diagnosed with uterine leiomyoma, the serum IgA level was 1.62 times
higher than in the control group (p < 0.05). Furthermore, the average IgA concentration in these
patients exceeded the upper limit of the normal range by 1.35 times (p < 0.05).
Conclusion:
According to our study, the examination and analysis of immunological
markers in pregnant women with leiomyoma is an effective method for early prediction of
disease progression and obstetric complications. Immunological monitoring not only allows for
evaluating the course of the condition but also enables the planning of preventive and
therapeutic measures based on an individualized approach.
Keywords
: Uterine leiomyoma, humoral immune response, leiomyoma and pregnancy
Relevance.
Uterine fibroid (leiomyoma, fibromyoma) is a benign tumour that develops
from the muscular layer of the uterus (myometrium). It consists of smooth muscle cells and
connective tissue. Fibroid is one of the most common gynaecological diseases in women of
reproductive age [1-4]. Uterine fibroids most often proceed asymptomatically, especially at early
stages of the disease, when fibroid nodes are small in size and small in number. However, in the
majority of women with fibroids there are alarming symptoms significantly reducing quality of
life [2,3]. The main complaints of patients are related to pain syndrome caused by growth of
fibroid nodes, as well as fatigue, weakness, apathy, menorrhagia and metrorrhagia, and chronic
anaemia. In addition, dyspareunia, psychological stress associated with the aforementioned
problems, and fear of possible medical interventions or reproductive dysfunction are often noted.
After disease onset these changes begin to be influenced by promoters (hormones) and
effector mechanisms (growth factors) [5,8]. The pathogenesis of uterine fibroid is a
multifactorial and complex process, which is based on genetic predisposition, hormonal
influences, changes in the immune system and tissue‐structural disorders. These mechanisms
mutually complement each other, contributing to disease development and formation of its
clinical picture.
Despite significant advances in studying the pathogenesis of uterine fibroid, the disease
still remains one of the most prevalent causes of surgical interventions in gynaecology.
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Until now, the clinical, morphological and endocrinological aspects of the disease have
been studied in greatest detail [6]. At the same time, many researchers emphasise the important
role of the immune system, in particular growth factors, in the pathogenesis of uterine fibroid
[5,7].
Recent scientific studies have shown that immunological mechanisms play an important
role in the development of fibroid and its complications. Using specific immunological markers
reflecting the immune response of the organism, it is possible to early identify the rate of fibroid
growth and risk of complications [4,8].
These differences become noticeable only at later stages of tumour growth, when cells
begin to change their properties [7,].
Objective of the study
-to assess humoral immunity in patients with uterine fibroid in
order to identify pathogenetic mechanisms of the pathological process.
Materials and methods.
In the gynaecological department of the maternity complex of
the city of Bukhara 36 patients diagnosed with uterine fibroid were examined. The mean age of
the women examined was 50.1 ± 4.09 years. In 64.0% of patients, ultrasound examination
revealed one fibroid node; in 36.0%-several nodes. The total volume of the uterus in 58.0% of
patients corresponded to 4-5 weeks of pregnancy, in 42.0% -to 6-9 weeks.
The majority of patients (57.0%) had no complaints characteristic of fibroid; 27.0%
reported painful periods, and 16.0%-pronounced and prolonged painful manifestations.
The control (donor) group consisted of 27 healthy women of comparable age to the
clinical group, who had no history of tumours of the uterus or other internal organs. In these
women the level of immunoglobulin A (IgA) was determined.
According to the researchers, circulating immune complexes (CIC) are an important
diagnostic criterion for assessing the degree of activation of the humoral component of the
immune system.
The level of immunoglobulin A in serum was determined by radial immunodiffusion.
Circulating immune complexes were measured by the method of Naskova et al., which is based
on nephelometry using polyethylene glycol (PEG) in the medium, as well as photocolorimetry
(KPK-2M atn) for assessing light scattering in the studied serum.
Discussion.
The study results showed that the mean level of IgA in the serum of women
in the control group was 1.85 ± 0.12 g/l, which falls within the lower and upper limits of normal-
from 1.46 to 2.22 g/l. In patients with uterine fibroid the IgA level was 1.62 times higher
compared to the control group (p < 0.05). The mean concentration of IgA in the patients
exceeded the upper normal limit by 1.35 times (p < 0.05). Individual analysis showed that only
14 (23.3%) of the patients with fibroid had IgA within the normal range, while 46 (76.6%) had
IgA above the upper normal limit. No patients with IgA below the norm were identified.
In the control group the mean concentration of circulating immune complexes (CIC) was
87.1 ± 8.2 arbitrary units. This indicator lies within the normal range, the upper limit of which is
104.3 arbitrary units. In patients with uterine fibroid the concentration of CIC in serum was
significantly increased and was 1.43 times higher than the average normal value (p < 0.05),
which is statistically significant.
Analysis of data revealed the following trend: in 7 (12%) of patients with fibroid the level
of CIC was within normal limits, in the remaining 53 (88%) this indicator was above normal.
This suggests high activation of the immune system in benign uterine tumours.
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It is currently known that formation of various pathological conditions is accompanied by
violation of cellular membrane integrity, which leads to their injury under the influence of free
oxidation radicals [8].
One of the common signs of tissue damage is membrane disruption and the release of
nuclear components, resulting in considerable amounts of DNA fragments appearing in the
bloodstream. The interaction of the immune system with DNA fragments leads to the formation
of autoantibodies, the level of which correlates with the degree of damage of cellular structures
[6,8].
Thus, the conducted analysis showed increased activity of humoral immunity in patients
with uterine fibroid, which is expressed in a significant increase in levels of IgA and circulating
immune complexes. These indicators have important diagnostic significance for understanding
the immunological basis of the pathological process.
The results of the study indicate that in patients with uterine fibroid experiencing pain
syndrome, the levels of circulating immune complexes and IgA are significantly above normal,
which points to activation of humoral immunity in the div. High levels of these immunological
indicators may indicate increased destructive processes and the presence of autoimmune
reactions.
These conditions underline the important role of immune mechanisms in the development
of the pathological process and are of great significance in the development of diagnostic and
therapeutic strategies.
Conclusion.
According to the results of our study, investigation and analysis of
immunological markers in women of reproductive age with uterine fibroid is an effective method
for early prediction of disease development and gynaecological complications. The study found
that uterine fibroid in pregnancy is associated not only with anatomical-physiological, but also
with immunological factors.
In women with uterine fibroid during pregnancy a disruption of normal adaptive immune
responses is observed. In particular, cytokine imbalance and insufficient formation of local
immunological tolerance negatively affect fetal development and the course of pregnancy.
This leads to disruption of immunological interactions between the fetus and the placenta,
which creates prerequisites for development of fetoplacental insufficiency, pre-eclampsia and
premature miscarriages.
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