Clinical and immunological aspects of early reproductive losses in patients with adenomyosis

Aim. To evaluate the clinical and immunological features of the early gestational period in patients with adenomyosis.

Materials and methods. The study included 110 patients with first spontaneous pregnancy in 6–9 weeks. 75 pregnant women with a history of grade 1 adenomyosis were divided into two groups: group 1 comprised 43 patients with a threatened miscarriage, group 2 included 32 patients without a threat of pregnancy termination. Group 3 (control) included 35 pregnant women without a burdened history with a physiological pregnancy course. The cytokine profile of peripheral blood and cervical mucus was studied, as well as the level of LL-37 (cathelicidin) antimicrobial peptide.

Results. A pro-inflammatory shift of the cytokine balance as well as increased pro-angiogenic activity, determined by the VEGF-R2 / VEGF-A ratio, were observed in pregnant women with grade 1 adenomyosis during a physiologically ongoing pregnancy in the 1st trimester. A threatened miscarriage in the presence of adenomyosis is accompanied by statistically significant changes in the cytokine profile, a decrease in pro-angiogenic activity and an increased level of LL-37 in cervical mucus.

Conclusion. Pregnancy with adenomyosis of the 1st degree, in the absence of other risk factors, is complicated by a threatened miscarriage in more than half of cases. The revealed clinical and immunological aspects of early reproductive losses require further in-depth study, since these signs may indicate the presence of chronic endometritis in patients with adenomyosis not determined by non-invasive research methods.