The role of vasoactive intestinal polypeptide in the development of gestational complications in women with repeat cesarean sections

Sebyakina T.A., Ivanova O.Yu, Ishunina T.A.

Kursk State Medical University of the Ministry of Health of Russia, Kursk, Russia

Background: Current obstetric and gynecological practice is characterized by increased caesarean section (CS) rates and CS-related prenatal and perinatal complications. The uterine scar is a potential risk factor for preterm birth, uterine rupture at the site of previous SC scar, preterm placental abruption, increased risk of placental insufficiency and other placenta-associated complications. 
Objective: Given the fact that vasoactive intestinal polypeptide (VIP) plays an important role in regulation of myometrial contractility and uteroplacental blood flow, the aim of the study was to investigate correlation between VIP expression in the myometrium and prenatal complications in women with repeat CSs.
Material and methods: The study was carried out in the Obstetric Emergency Hospital in Kursk. Complex medical examination of 21 women after repeat СS at 37–41 weeks of pregnancy was performed including general and obstetric anamnesis; obstetric examination; ultrasound and Doppler ultrasound; immunohistochemical staining of biopsy material of uterine tissues, using polyclonal antibodies that recognize VIP; pathomorphological examination of the placenta; analysis of сomplete blood count and calculation of the Garkavi index.
Results: Negative correlation was found between VIP expression in the myometrium and the concentration of leukocytes (p=0.012), and positive correlation was found between VIP expression in the myometrium and the percentage of lymphocytes and the Garkavi index (p=0.031). In women with low expression of VIP, decreased placental mass (p = 0.0009), abnormal placental function, calcium deposits, foci of fibrosis and pseudo-infarction that manifested placental insufficiency, were found.
Conclusion: Low expression of VIP in the myometrium is associated with pelvic inflammatory disease, increased concentration of leukocytes, reduced level of lymphocytes and high rate of placental insufficiency, possibly due to immunological disorders associated with VIP deficiency. High expression of VIP in the myometrium is associated with preeclampsia and is considered to be a compensatory mechanism that can improve uterine and placental blood flows.

Authors' contributions: Sebyakina T.A., Ishunina T.A. – the concept and design of the study, statistical data processing; Sebyakina T.A. – material collection and processing; Sebyakina T.A., Ivanova O.Yu., Ishunina T.A. – article writing; 
Ivanova O.Yu., Ishunina T.A. – article editing.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was carried out without any sponsorship. 
Ethical Approval: The study was approved by the Regional Ethics Committee.
Patient Consent for Publication: The patients have signed informed consent for publication of their data. 
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Sebyakina T.A., Ivanova O.Yu, Ishunina T.A.  The role of vasoactive intestinal polypeptide 
in the development of gestational complications in women with repeat cesarean sections.
Akusherstvo i Gynecologia/Obstetrics and Gynecology (in Russian). 2024; 12: 42-49 (in Russian)
https://dx.doi.org/10.18565/aig.2024.202 

Keywords

placental insufficiency
vasoactive intestinal polypeptide
the Garkavi index
repeat cesarean section
inflammation
preeclampsia

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Received 09.08.2024

Accepted 28.11.2024

About the Authors

Tatyana A. Sebyakina, PhD, Teaching Assistant at the Department of Obstetrics and Gynecology, Kursk State Medical University, Ministry of Health of Russia, 305041, Russia, Kursk, K. Marks str., 3, +7(920)262-20-11, doctor_gyn11@mail.ru, 0009- https://orcid.org/0007-6706-549X
Oksana Yu. Ivanova, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology, Kursk State Medical University, Ministry of Health of Russia, 305041, Russia, Kursk, K. Marks str., 3, +7(905)041-82-89, ivonavao1@mail.ru, https://orcid.org/0000-0003-2350-1740
Tatjana A. Ishunina, Dr. Med. Sci., Professor at the Department of Histology, Embryology, Cytology, Kursk State Medical University, Ministry of Health of Russia, 305041, Russia, Kursk, K. Marks str., 3, +7(960)689-19-79, ishunina@gmail.com, https://orcid.org/0000-0002-2743-7515
Corresponding author: Tatyana A. Sebyakina, doctor_gyn11@mail.ru

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