Comparıng of the dıstrıbutıon of molecular proangıogenıc factors ın endometrıum of mıssed abortıon and voluntary fırst trımester termınatıon cases

Aim: In this study, we have compared distribution of factors that involved in angiogenesis in desiduas of missed abortion and voluntary termination cases to investigate the role of angiogenesis in the etiology of missed abortion.Materials and Methods: Desidual materials were collected from patients that are diagnosed missed abortion (n=19) and legal voluntary termination cases (n=15) under 10 gestastational week. Tissue samples were collected from each group by dilatation curettage (D&C) under mask anesthesia. Materials were devided into two groups for examination. For all samples, Nitric Oxide synthase isoforms (eNOS ve iNOS), Hypoxia inducible factor-1 alpha, Vascular endothelial growth Factor (VEGF), VEGF receptors [VEGF-R1 (flt-1), VEGF-R2 (flk-1)] and Thrombospondin-1 immunohistochemical staining were performed. The number of stained cells was calculated using H-Score technique.Results: Missed abortion group (n=19) mean age was 28.7 (18- 41) and control group (n=15) mean age was 27.5 (21-37). 17 of 34 patiens admitted to the study were nullipar. 11 patiens were nullipar in missed abortion group and 7 in control group. There is no significant difference between the two groups in terms of obstetric history. In histochemical examination, at missed abortion group a lower vessel formation and structuring of trophoblast viewed. In imunohistochemical examination at missed abortion group, VEGF, eNOS, and FLT-1 immunoreactivity were detected lowerin decidual vascular cells. Flk-1 immunoreactivity were detected higher. Between the two groups significantly (p <0.005) difference was found. HIF immunoreactivity was higher than the control group?s cytotrophoblast and the difference was significantly (p <0.05). With immunohystochemistrical examination of Thrombospondin-1 and iNOS, in desidua and plasental vascular cells, when compared with the control group, it was seemed to have more stainning in missed abortion group and it was significantly different (p <0.005).Conclusion: It is shown that compared with healthy pregnants, in missed abortion cases the vascular development is unsufficient. In these cases, the expression of angiogenic factors decreases oppositely, the anti-angiogenic factors incerases. A sufficient angiogenesis is essential for the formation and continuing of a healthy pregnancy. If the balance between angiogenic and anti-angiogenic factors deteriorates, angiogenesis cannot be controled and may result with the loss of pregnancy.