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首页> 外文期刊>Journal of Reproductive Immunology >Acute inflammation in the uterine isthmus coincides with postpartum acute myometritis in the uterine body involving refractory postpartum hemorrhage of unknown etiology after cesarean delivery
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Acute inflammation in the uterine isthmus coincides with postpartum acute myometritis in the uterine body involving refractory postpartum hemorrhage of unknown etiology after cesarean delivery

机译：子宫炎症中的急性炎症与子宫身体的产后急性肌瘤炎均匀涉及剖宫产后未知病因的难治性产后出血

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摘要

Uterine atony is a major cause of postpartum hemorrhage. We recently proposed the new histological concept of postpartum acute myometritis (PAM) for the pathophysiology of refractory uterine atony of unknown etiology, which is characterized by the diffuse activation of mast cells and the complement system as well as the massive infiltration of macrophages and neutrophils into the uterine body. We herein focused on the uterine isthmus just adjacent to the body. The isthmus becomes significantly elongated throughout pregnancy. It is composed of myocytes and fibroblasts with an extracellular matrix that forms a passive lower segment during labor. The aim of this study was to histologically examine the uterine isthmus in cases of PAM in the uterine body. Under the amniotic fluid embolism-registry program in Japan, we selected PAM cases from uterine samples obtained by cesarean hysterectomy and delivered to us for analyses between 2011 and 2017. Control tissues were collected during elective cesarean section. We investigated the isthmus tissues of these cases and performed immunohistochemistry for inflammatory cell markers, i.e. neutrophil elastase, mast cell tryptase, CD68, CD3, and C5a receptor (C5aR). The numbers of tryptase-positive degranulating mast cells, elastase-positive neutrophils, CD68-positive macrophages, and C5aR-positive cells in the isthmus were significantly higher in uteri with PAM in the body than in controls without PAM. CD3 was negative in both groups. In conclusion, inflammation and an anaphylactoid reaction were histologically detected not only in the uterine body, but in the isthmus among cases of refractory PPH of unknown etiology after cesarean section.
机译：子宫透明是产后出血的主要原因。我们最近提出了产后急性肌瘤炎（PAM）的新组织学概念，用于未知病因的难治性子宫内炎的病理生理学，其特征在于粘液细胞和补体系统的弥漫性激活以及巨噬细胞和中性粒细胞的大规模渗透子宫身体。我们在本文中聚焦在毗邻身体的子宫峡部。在妊娠期间，峡部变得显着伸长。它由肌细胞和成纤维细胞组成，其具有细胞外基质，其在劳动期间形成被动下部段。本研究的目的是在子宫体中的PAM病例中组织学上检查子宫肌肌。在日本的羊水栓塞方案下，我们选择了PAM病例，从剖腹产镜分析术获得的子宫样品，并送给我们2011年间分析。在选举剖宫产期间收集了对照组织。我们研究了这些病例的峡部组织，并对炎症细胞标志物进行免疫组织化学，即中性粒细胞弹性蛋白酶，肥大细胞胰蛋白酶，CD68，CD3和C5a受体（C5AR）。胰蛋白酶阳性滴肥大细胞，弹性蛋白酶阳性中性粒细胞，CD68阳性巨噬细胞和C5AR阳性细胞的数量在UTER中具有显着高于体内的PAM，而不是在没有PAM的对照中。 CD3在两组中为阴性。总之，炎症和过敏反应不仅在子宫体内检测到组织学，但在剖宫产后未知病因的难治性PPH中的峡部中。

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