Histopathological Study of Villous Morphology in Spontaneous First Trimester Abortions
Keywords:
chorionic villi, fibrosis, vascularity, stromal fibrosisAbstract
BACKGROUND: First trimester abortions are seen in 10 – 20 % of pregnancies. Sending the tissue evacuated after miscarriage for histopathological examination till date is a topic of debate as some professionals feel it is a waste of time and expensive, while on the other hand a school of thought still persists on doing the same.
METHODS: We studied the various histopathological changes seen in the abortus tissue in first trimester spontaneous abortions over a period of one year from January to December 2015. A total of 100 slides and requests for histopathological examination of first trimester abortions were retrieved and studied in detail by two pathologists for the following features- Villous size, contour, vasculature, trophoblastic proliferation, perivillous and intervillous hemorrhage, perivillous fibrin deposition, stromal fibrosis, inflammation and decidual change. The observed changes were also categorized according to the weeks of abortion. Appropriate statistical tests were employed.
RESULTS: Our study showed many dysmorphic features in the villi like reduced vessels per  villous (72%), fibrosis (21.3%), hydropic change (32%) and abnormal trophoblastic  proliferation (49%). Other features noted were villous hydrops, inter and perivillous fibrin deposition, inflammation, decidual change and Arias Stella reaction. Reduced vessels per villi and hydropic change were significantly associated with abortions happening at 8 - 10 weeks, while reduced patency of vessels, abnormal villous contour, ghost villi and  trophoblastic proliferation were more associated with earlier dated abortions.
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CONCLUSION: Cases with dysmorphic features as seen in the present study are known to be associated with clinically significant conditions like diabetes, eclampsia and with certain chromosomal abnormalities. Such cases can not only be filtered for cytogenetic work up, but documentation of these features can also aid in counselling and planning of future pregnancies. Thus histopathological examination of abortus material is highly recommended.
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