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| Spontaneous Abortion |
| Etiology • Chromosomal abnormalities including triploidy, trisomy (reported for every chromosome), monosmy X (Turner's syndrome), among others. • Problems with mainintaing implantation including antiphospholipid antibody syndrome • Unknown |
| Pathogenesis • Chromosomal abnormalities may result in fetal death with subsequent death of the placenta. • Unknown what effect chromosomal abnormalities have on the placenta's function. • Antiphospholipid antibody syndrome is associated with abnormal decidual vascularization and thrombosis of decidual vessels with abruption. • Ascending infection leads to membrane rupture and premature delivery. • Anatomic cervical incompetence can also lead to miscarriage., |
| Epidemiology • Human pregnancy generates large numbers of spontaneous losses. • Estimates of the percentages of conceptions that fail to reach term has increased with the advent of early detection methods. • Greater than 25% of pregnancies end spontaneously. • Current estimates are that approximately 50% of first trimester losses (by far the most common) are secondary to chromosomal abnormalities. • Increasing spontaneous abortion rate with age. • Some women are habitual aborters. |
| General Gross Description • An empty sac or disorganized embryonic tissues (identified by microscopy) may be secondary to early fetal demise. • Alternatively the fetus may be delivered within the amnionic sac followed by the placenta. |
| General Microscopic Description • Findings vary with etiology of the loss. • Common to all is an implantation site with acute hemorrhage and inflammation. • Decidualized endometrium is generally sloughed as well. • The villi may show infarct or intervillositis in cases associated with euploidy. • The villi may show a complex villus outline, trophoblastic inclusions, and calcifications in aneuploid gestations. • Histologic abnormalities can be demonstrated in the fetus. |
| Clinical Correlation • Most women are not habitual aborters. • An attempt to categorize the miscarriage as either secondary to chromosomal abnormalities or euploidy is useful in the management of women with recurrent losses. • Aneuploid losses may repeat with advanced maternal age. Also will repeat if parent carries a balanced translocation (very rare). • Euploid losses may repeat but intervention with aspirin and/or heparin may permit maintenance of a subsequent pregnancy to viability. |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1078-9. |
| Spontaneous Abortion |
| Synopsis by: Melinda Sanders M.D. (T89000M35250)[616] |
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