PLACENTAL GROWTH FACTOR AS A MARKER OF THE THREATENED EARLY MISCARRIAGE IN WOMEN WITH CYTOMEGALOVIRUS INFECTION

Abstract

The aim of study was to establish the dependence of the threatened early miscarriage on the level of placental growth factor (PlGF) in the blood of pregnant women with different activity of cytomegalovirus (CMV) infection. There was conducted a prospective study by case-control type of 100 women at 9-11 weeks of gestation, among whom 83 were CMV-seropositive and 17 were CMV-seronegative. Further categorization into subgroups was performed taking into account the markers of CMV replication activity and the nature of pregnancy complications. Markers of highly active CMV infection and a significant decrease of PlGF in the blood (p<0.001) of CMV-seropositive women whose pregnancy ended with spontaneous abortion at 10-11 weeks of gestation were revealed in 15.7% of cases. In 53% of cases, pregnancy was complicated by the threatened miscarriage, but with subsequent prolongation. In this subgroup with less expressed activity of CMV, PlGF values were higher (p<0.01). In 31.3% of cases, the latent course of the disease was diagnosed, where the level of the enzyme did not significantly differ from those in the control group, which correlated with the minimal risk of development of the threatened miscarriage. Morphological study of the villous chorion from CMV-seropositive women with spontaneous miscarriage revealed cytomegalic cells in the trophoblast, multiple avascular and necrotic villi. The obtained data shows the CMV dependent inhibition of secretion of the PlGF by trophoblast cells, which is determined by the level of viral activity and leads to the violation of placental morphology and reduction of placental blood flow, intrauterine growth restriction and at the high viral load - to fetal death induced by it.