Structural foundations for the development of hypertensive complications of pregnancy following oocyte donation in surrogate mothers
Objective. To assess structural changes of the placenta and the placental bed in pregnancy with the allogeneic fetus as reflecting impaired immunological tolerance and the formation of a substrate for the development of hypertensive complications of pregnancy.
Patients and methods. 89 patients were examined, whose pregnancy resulted from IVF: 47 patients under the surrogate motherhood programme (IVF-SM) and 42 women after IVF with the use of donor oocytes (IVF-OD). The control group comprised 21 patients, whose pregnancy occurred following IVF with own oocytes (IVF-OO). Subgroups were formed according to the presence or absence of the clinical signs of moderate or severe preeclampsia (PE). Morphological examination was performed on placental material (placental discs) and the placental bed obtained after childbirth.
Results. In the development of preeclampsia, the signs of immune alteration of the placenta have approximately the same severity in groups following IVF-SM, IVF-OD and IVF-OO, which confirms the theory of the immune pathogenesis of PE. In uncomplicated allogeneic pregnancy, placentas are also characterised by the signs of immune alteration that are significantly more marked than those in the control group. Pregnancy occurring after IVF-OD is characterised by fetal-maternal immunological stress, which is manifested by the structural changes in placentas. The structure of the placenta and the placental bed against the background of allogeneic pregnancy is characterised by signs of impaired trophoblast invasion during the first and second waves of gestation and immune affection of the placenta.
Conclusion. Pregnancy with the use of an allogeneic egg has a higher risk for the development of hypertensive complications, in particular, gestational arterial hypertension and PE. Structural specificities of the placenta and the placental bed reflect immune stress in the «mother-fetus» system.
Key words: gestational arterial hypertension, oocyte donation, preeclampsia, surrogate motherhood, IVF.
For citation: Rudenko E.E., Kogan E.A., Trifonova N.S., Zhukova E.V., Demura Т.А., Aleksandrov L.S., Ishchenko A.I., Zharkov N.V., Bayanova S.N.,
Lavrentyeva K.I. Structural foundations for the development of hypertensive complications of pregnancy following oocyte donation in surrogate mothers.
Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2020; 19(1): 58–67. (In Russian). DOI: 10.20953/1726-1678-2020-1-58-67