Organization of structural components of the uterine lymphatic system during pregnancy or in the absence of it (literature review)

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Abstract

The uterus is structurally an unique organ, the endometrium of which undergoes constant cyclical changes with the onset of puberty of the body. Little is known about the presence of lymphatic vessels in the endometrium of the uterus during pregnancy or outside of this condition, although the presence of lymphatic vessels in the myometrium and perimetrium has been established. Considering the importance of lymphatic vessels in other organs and tissues, lymph circulation through them can play a key role in establishing and maintaining pregnancy. The aim of the work is to summarize the literature data on the presence of structural components of the lymphatic system in the uterine wall during pregnancy or in the absence of it. The search for literature on the topic of the work was carried out using the e-library and Pubmed databases up to and including 12.11.2025 in accordance with the PRISMA methodology. In the early stages of pregnancy (I trimester), lymphangiogenesis occurs in the endometrium of the uterus, stimulated by cytotrophoblasts and NK cells, which ensures the outflow of intercellular fluid and protects the fetus from triggering a rejection reaction. It has been shown that human trophoblasts produce molecules that promote the formation of lymphatic vessels in the endometrium of the uterus during pregnancy, such as VEGF-C, Ang-2, as well as D2-40 and LYVE-1. In late pregnancy (II and III trimesters), lymphatic vessels are not found in the mature placenta, which may be due to active suppression of their growth (antilymphangiogenesis). At the same time, none of the main lymphatic markers – PROX-1, VEGFR-3, LYVE1 and D2-40 – are expressed by endothelial cells of placental vessels, which suggests that the role of markers of lymphangiogenesis is likely to decrease with the development of pregnancy. The additional experimental studies are needed to confirm this hypothesis. The lymph outflow from the myometrium and perimetrium of the uterus during pregnancy coincides with that in the absence of it.

About the authors

Elena N. Morozova

Belgorod State National Research University

Author for correspondence.
Email: tiger2910@rambler.ru
ORCID iD: 0000-0002-6117-080X

Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of Human Anatomy and Histology

Russian Federation, Belgorod

Anastasiya V. Karpikova

Belgorod State National Research University

Email: karp5002@mail.ru
ORCID iD: 0009-0005-6170-5754

student, speciality “General Medicine”

Russian Federation, Belgorod

Vitaliy N. Morozov

Belgorod State National Research University

Email: vitaliyymorozov85@mail.ru
ORCID iD: 0000-0002-1169-4285

Doctor of Medical Sciences, Associate Professor, Associate Professor of the Department of Human Anatomy and Histology

Russian Federation, Belgorod

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