Recurrent Pregnancy Wastage
Histology of Products of Conception
DOI:
https://doi.org/10.21276/apalm.2059Keywords:
recurrent, abortion, histologyAbstract
Background: Histopathologic examination of products of spontaneous abortion is done to identify pregnancy- molar or ectopic. Also, in the perspective of recurrent abortion, additional diagnostic information can be obtained. We studied products of conception with the aim to find if it is of any value in recurrent pregnancy wastage.
Methods: Data was obtained from patients with the diagnosis of recurrent spontaneous abortion. The samples were examined macroscopically and microscopically by a competent histopathologist.
Results: Age of the patients ranged from 23-36 years. Majority of the recurrent abortions occurred during 10-15 weeks of gestation accounting for 41 (65.07%) cases. Recurrences ranged from third to fifth time loss contributing to 44 (69.84%), 14 (22.22%) and 5 (7.93%) cases respectively. Villous oedema of chorionic villi were seen in 30 (47.61%) cases. Abnormal vascularity in the form of complete avascularity of villi was observed in 8 (12.69%) cases. 50 (79.36%) cases showed fibrinoid degeneration. Amongst the 50 cases, 30 (60%) cases showed both perivillous and intravillous fibrin while 20 (40%) cases showed only perivillous fibrin deposition. 30 cases (47.61%) showed evidence of chronic villitis. The 30 cases were subdivided into “infectious villitis“ and “villitis of unknown etiology“ (VUE). Infectious villitis was seen in only 1 case (3.3%) which showed presence of toxoplasmal cysts and plasma cell infiltration. Deciduitis was observed in 31 (49.20%) cases. Decidual necrosis was seen in 23 (36.50%) cases. 3 (4.76%) cases of partial mole were diagnosed. 4 (6.34%) cases each of syncitial knots and villous infarction were seen. We did not encounter any cases of chronic intervillositis and chronic endometritis.
Conclusion: It is rational to perform histopathological examination routinely for all recurrent miscarriages.
References
2. van den Boogaard E, Kaandorp SP, Franssen MT, Mol BW, Leschot NJ, Wouters CH, van der Veen F, Korevaar JC, Goddijn M. Consecutive or non-consecutive recurrent miscarriage: is there any difference in carrier status? Hum Reprod 2010;25(6):1411-4..
3. Haque AU, Siddique S, Jafari MM, Hussain I, Siddiqui S. Pathology of chorionic villi in spontaneous abortions. Int J of Pathol. 2004; 2: 5-9.
4. Jindal P, Regan L, Fourkala E, Rai R, Moore G, Goldin R, Sebire N. Placental pathology of recurrent spontaneous abortion: the role of histopathological examination of products of conception in routine clinical practice: a mini review. Human Reproduction 2007; 22(2):313–316.
5. Chaithra PT, Kavitha P, Sreenivasa G, Malini SS. Recurrent Pregnancy Loss – Is It Advanced Age or Advanced Maternal Mother’s Age of Young Women a Major Contributing Factor. IOSR-JDMS, 2015; 14(4): 81-87
6. Grande M, Borrell A, Garcia-Posada R, Borobio V, Muñoz M, Creus M et al. () The effect of maternal age on chromosomal anomaly rate and spectrum in recurrent miscarriage. Hum Reprod 2012; 27(10): 3109–3117
7. Ticconi C, Giuliani E, Sorge R, Patrizi L, Piccione E, Pietropolli A. Gestational age of pregnancy loss in women with unexplained recurrent miscarriage. J Obstet Gynaecol Res. 2016; 42(3):239-45.
DOI: 10.1111/jog.12903.
8. Coccia ME, Rizzello F, Capezzuoli T, Spitaleri M, Riviello C. Recurrent pregnancy losses and gestational age are closely related: an observational cohort study on 759 pregnancy losses. Reprod Sci. 2015;22(5):556-62.
.
9. Gartner AB. Confined Placental Mosaicism in Spontaneous Abortions. (Doctoral dissertation, Vancouver, Canada: The University of British Columbia;1991.
10. Houwert-de Jong MH, Bruinse HW, Eskes TK, Mantingh A, Termijtelen A, Kooyman CD. Early recurrent miscarriage: histology of conception products. Br J Obstet Gynaecol. 1990;97(6):533-5
11. Ahlam A. Al-Ghamdi. Recurrent hydatidiform mole: A case report of six consecutive molar pregnancies complicated by choriocarcinoma, and review of the literature. J Family Community Med. 2011; 18(3): 159–161.
12. Fisher RA, Hodges MD, Newlands ES. Familial recurrent hydatidiform mole: a review. J Reprod Med. 2004 Aug;49(8):595-601.s
13. Joshi VV. Handbook of Placental Pathology. New York: IGaku-Shoin; 1994.
14. Van Horn JT, Craven C, Ward K, Branch DW, Silver RM. Histologic features of placentas and abortion specimens from women with antiphospholipid and antiphospholipid-like syndromes. Placenta. 2004;25(7):642-8.
.
15. Whitten A.E., Romero R., Korzeniewski S.J., Tarca A.L., Schwartz A.G., Yeo L., Dong Z, ChaiworapongsaT. Evidence of an imbalance of angiogenic/antiangiogenic factors in massive perivillous fibrin deposition (maternal floor infarction): A placental lesion associated with recurrent miscarriage and fetal death. American Journal of Obstetrics and Gynecology 2013; 208 (4):310.e1-310.e11.
16. Sebirea N.J, M. Backosb, R.D. Goldina, L. Regan. Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome Br J Obstet Gynaecol 2002; 109: 570–573.
17. Baergen RN. Manual of Pathology of the Human Placenta. New York Dordrecht Heidelberg London: Springer Science & Business Media; 2011. 299 – 312.
18. Redline R.W., Abramowsky C.R. Clinical and pathologic aspects of recurrent placental villitis. Hum Pathol 1985;16 (7):727-731.
19. Doss BJ, Greene MF, Hill J, Heffner LJ, Bieber FR, Genest DR. Massive chronic intervillositis associated with recurrent abortions. Hum Pathol. 1995 Nov; 26(11):1245-51.
20. Boyd TK, Redline RW. Chronic histiocytic intervillositis: a placental lesion associated with recurrent reproductive loss. Hum Pathol. 2000;31(11):1389-96
21. Kitaya K. Prevalence of chronic endometritis in recurrent miscarriages. Fertility and Sterility 2011; 95 (3):1156-1158.
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