Pathology of Spontaneous Abortion


Any account of the pathology of spontaneous abortion must suffer from the restraints placed upon the pathologist by the type of material made available for study. In the vast majority of first trimester abortions all that is received in the laboratory is placental tissue and decidua: fetal tissues may or may not be present but it is rather uncommon to receive either an intact fetus or a complete gestational sac. The emphasis of this chapter will, therefore, be on the pathology of the placenta in spontaneous abortion, with little attention being paid to the embryo.


Spontaneous Abortion Hydatidiform Mole Spiral Artery Early Pregnancy Loss Intervillous Space 
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  1. Benirschke K, Driscoll SG (1967) The pathology of the human placenta. Springer-Verlag, Berlin Heidelberg New YorkGoogle Scholar
  2. Bennett SJ (1987) Congenital abnormalities of the fundus. In: Bennett MJ, Edmonds DK (eds) Spontaneous and recurrent abortion. Blackwell, Oxford, pp 109–129Google Scholar
  3. Berry CL (1980) The examination of embryonic and fetal material in diagnostic histopathology laboratories. J Clin Pathol 33:317–326PubMedCrossRefGoogle Scholar
  4. Bulmer JN, Ritson A (1988) The decidua in early pregnancy. In: Beard RW, Sharp F (eds) Early pregnancy loss; mechanisms and treatment. Springer-Verlag, London, pp 171–180Google Scholar
  5. Carreras LO, Defreyn G, Machin SJ et al. (1981) Arterial thrombosis, intrauterine death and the “lupus” antocoagulant: detection of immunoglobulin interfering with prostacyclin formation. Lancet 1:244–246PubMedCrossRefGoogle Scholar
  6. Charles D, Larsen B (1990) Spontaneous abortion as a result of infection. In: Huisjes HJ, Lind T (eds) Early pregnancy failure. Churchill Livingstone, Edinburgh, pp 161–176Google Scholar
  7. Clark DA (1988) Host immunoregulatory mechanisms and the success of the conceptus fertilised in vivo and in vitro. In: Beard RW, Sharp F (eds) Early pregnancy loss: mechanisms and treatment. Springer-Verlag, London pp 215–227Google Scholar
  8. Clark DA, Moybray J, Underwood J, Liddell H (1987) Histopathologic alterations in the decidua of spontaneous human abortion: loss of cells with large cytoplasmic granules. Am J Reprod Immunol Microbiol 13:19–22PubMedGoogle Scholar
  9. Davis JR, Kerrigan DP, Way DM, Weiner SA (1987) Partial hydatidiform moles: deoxyribonucleic acid content and course. Am J Obstet Gynecol 157:969–973PubMedGoogle Scholar
  10. Derne DJ, Englert HJ, Harris EN et al. (1985) Fetal loss in systemic lupus: association with anticardiolipin antibodies. J Obstet Gynaecol 5:207–209CrossRefGoogle Scholar
  11. De Wolf F, Carreras LO, Moerman P, Vermylen J, van Assche A, Renaer M (1982) Decidual vasculopathy and extensive placental infarction in a patient with thromboembolic accidents, recurrent fetal loss, and a lupus anticoagulant. Am J Obstet Gynecol 142:829–834PubMedGoogle Scholar
  12. Fox H (1978) Pathology of the placenta. Saunders, PhiladelphiaGoogle Scholar
  13. Fujikura J, Froehlich LA, Driscoll SG (1966) A simplified anatomic classification of abortions. Am J Obstet Gynecol 95:902–905PubMedGoogle Scholar
  14. Geisler K, Kleinebrecht J (1978) Cytogenetic and histologic analysis of spontaneous abortion. Hum Genet 45:239–251PubMedCrossRefGoogle Scholar
  15. Geneva Conference (1966) Standardisation of procedures for chromosome studies in abortion. Cytogenetics 5:361–393CrossRefGoogle Scholar
  16. Gocke H, Muradow I, Cremer H (1982) Morphologische und zytogenetische Befunde bei Fruhaborten Ver Dtsch Ges Pathol 66:141–146Google Scholar
  17. Gocke H, Schwanitz G, Muradow I, Zerres K (1985) Pathomorphologie und Genetik iin der Fruhschwangerschaft. Pathologe 6:249–259PubMedGoogle Scholar
  18. Harris EN (1988) Clinical and immunological significance of anti-phospholipid antibodies. In: Beard RW, Sharp F (eds) Early pregnancy loss: mechanisms and treatment. Springer-Verlag, London, pp 43–60Google Scholar
  19. Hemming JD, Quirke P, Womack C, Wells M, Elston CW, Bird CC (1987) Diagnosis of molar pregnancy and persistent trophoblastic disease. J Clin Pathol 40:615–620PubMedCrossRefGoogle Scholar
  20. Hertig AT (1968) Human trophoblast. Thomas, Springfield, IllinoisGoogle Scholar
  21. Honore LH, Dill FJ, Poland BJ (1976) Placental morphology in spontaneous human abortions with normal and abnormal karotypes. Teratology 14:151–166PubMedCrossRefGoogle Scholar
  22. Houwert-de Jong MH (1989) Habitual abortion: views and fact-finding. Thesis, University of UtrechtGoogle Scholar
  23. Houwert-de Jong MH, Bruinse HW, Eskes TKAB, Mantingh A, Termijtelen A, Kooyman CD (1990a) Early recurrent miscarriage; histology of conception products. Br J Obstet Gynaecol 97:533–535CrossRefGoogle Scholar
  24. Houwert-de Jong MH, Bruinse HW, Termijtelen A (1990b) The immunology of normal pregnancy and recurrent abortion. In: Huisjes HJ, Lind T (eds) Early pregnancy failure. Churchill Livingstone, Edinburgh, pp 27–38Google Scholar
  25. Hustin J, Schaaps JP, Lambotte R (1988) Anatomical studies of the utero-placental vascularization in the first trimester of pregnancy. Trophoblast Res 3:49–60Google Scholar
  26. Hustin J, Jauniaux E, Schaaps JP (1990) Histological study of the materno-embryonic interface in spontaneous abortion. Placenta 11:477–486PubMedCrossRefGoogle Scholar
  27. Jacobs PA, Szulman AE, Fumkhouser J, Matsuura R, Wilson CC (1982) Human triploidy: relationship between paternal origin of additional haploid complement and development of partial hydatidiform mole. Ann Hum Genet 46:225–231CrossRefGoogle Scholar
  28. Kalousek DK, Barrett IJ, McGillivray BC (1989) Placental mosaicism and intrauterine survival of trisomies 13 and 18. Am J Hum Genet 44; 338–343PubMedGoogle Scholar
  29. Katsura M (1989) Effect of human recombinant interleukin-I-alpha on glycosaminoglycan and collagen metabolism in cultured human chorionic cells. Acta Obstet Gynaec Jap 41:1943–1950Google Scholar
  30. Khong TY, De Wolf F, Robertson WB, Brosens I (1986) Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small for gestational age infants. Br J Obstet Gynaecol 93:1049–1059PubMedCrossRefGoogle Scholar
  31. Khong TY, Liddell HS, Robertson WB (1987) Defective haemochorial placentation as a cause of miscarriage: a preliminary study. Br J Obstet Gynaecol 94:649–655PubMedCrossRefGoogle Scholar
  32. Labarrere CA, Faulk WF, Mclntyre JA (1989) Villitis in normal human term placentae: frequency of the lesion determined by monoclonal antibody to HLA-DR antigen. J Reprod Immunol Microbiol 16:127–135CrossRefGoogle Scholar
  33. Labarrere CA, Mclntyre JA, Faulk WP (1990) Immunohistologic evidence that villitis in human normal term placentas is an immunologic lesion. Am J Obstet Gynecol 162:515–522PubMedGoogle Scholar
  34. Lage JM, Weinberg DS, Yavner DL, Bieber FR (1989) The biology of tetraploid hydatidiform moles: histopathology, cytogenetics and flow cytometry. Hum Pathol 20:419–425PubMedCrossRefGoogle Scholar
  35. Laurini RN (1990) Abortion from a morphological viewpoint. In: Huisjes HJ, Lind T (eds) Early pregnancy failure. Churchill Livingstone, Edinburgh, pp 79–113Google Scholar
  36. Lawler SD, Fisher RA, Pickhall VJ, Povey S, Evans MW (1982) Genetic studies on hydatidiform moles. 1. The origin of partial moles. Cancer Genet Cytogenet 5:309–320PubMedCrossRefGoogle Scholar
  37. Lockshin MD, Druzin ML, Goei S et al. (1985) Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med 313:152–156PubMedCrossRefGoogle Scholar
  38. Lockshin MD, Quamar T, Druzin ML, Goei S (1987) Antibody to cardiolipin, lupus anticoagulant, and fetal death. J Rheumatol 14:259–262PubMedGoogle Scholar
  39. Mall FP, Meyer AW (1921) Studies on abortuses: a study of pathologic ova in the Carnegie embryological collection. Contrib Embryol Carnegie Inst Washington 12:1–364Google Scholar
  40. Matorras R, Garcia-Perea A, Omenaca F, Usandizaga JA, Nieto A, Herruzo R (1989) Group B streptococcus and premature rupture of the membranes and premature delivery. Gynecol Obstet Invest 27:14–18PubMedCrossRefGoogle Scholar
  41. McDonald H, Vignerwaran R, O’Loughlin JA (1989) Group B streptococcal colonization and preterm labour. Aust N Z J Obstet Gynaecol 29:291–293PubMedCrossRefGoogle Scholar
  42. Michel M, Underwood J, Clarke DA, Mowbray JF, Beard RW (1989) Histologic and immunologic study of uterine biopsy tissue of women with incipient abortion. Am J Obstet 161, 409–414Google Scholar
  43. Michel MZ, Khong TY, Clark DA, Beard RW (1990) A morphological and immunological study of human placental bed biopsies in miscarriage. Br J Obstet Gynaecol 97:984–988PubMedCrossRefGoogle Scholar
  44. Minguillon C, Eiben B, Bahr-Porsch S, Vogel M, Hansmann H (1989) The predictive value of chorionic villus histology for identifying chromosomally normal and abnormal spontaneous abortions. Hum Genet 82:373–376PubMedCrossRefGoogle Scholar
  45. Muntefering R, Dallenbach-Hellweg G, Ratschek M (1988) Pathologische-anatomische Befunde bei der gestorten Fruhschwangerschaft. Gynakologie 21:262–272Google Scholar
  46. Naeye RL (1987) Functionally important disorders of the placenta, umbilical cord and fetal membranes. Hum Pathol 18:681–691Google Scholar
  47. Novak R, Agamonalis D, Dasu S et al. (1988) Histological analysis of placental tissue in first trimester abortions. Paediat Path 8:477–482CrossRefGoogle Scholar
  48. Ohama K, Ueda K, Okamoto M, Takemata M, Fujiwara A (1986) Cytogenetic and clinicopathological studies of partial moles. Obstet Gynecol 68:259–262PubMedGoogle Scholar
  49. Philippe E (1973) Morphologie et morphometrie des placentas d’aberration chromosomique fetale. Rev Fr Gynecol Obstet 68:645–649Google Scholar
  50. Philippe E, Boué J (1969) Le placenta dan les aberrations chromosomique fetales. Ann Anat Pathol 14:249–266Google Scholar
  51. Rehder H, Coerdt W, Eggers R, Klink F, Schwinger E (1989) Is there a correlation between morphological and cytogenetic findings in placental tissue from early missed abortions? Hum Genet 82:377–385PubMedCrossRefGoogle Scholar
  52. Robertson WB, Brosens I, Dixon HG (1967) The pathological response of the vessels of the placental bed in hypertensive pregnancy. J Pathol Bacteriol 85:581–592CrossRefGoogle Scholar
  53. Robertson WB, Brosens I, Dixon HG (1975) Uteroplacental vascular pathology. Eur J Obstet Gynecol Reprod Biol 5:47–65PubMedCrossRefGoogle Scholar
  54. Rockelein G, Schroder J, Ulmer R (1989) Korrelation von Karotyp und Plazentamorphologie beim Fruhabort. Pathologe 10:306–314PubMedGoogle Scholar
  55. Rushton DI (1981) Examination of products of conception from previable human pregnancies. J Clin Pathol 34:819–835PubMedCrossRefGoogle Scholar
  56. Rushton DI (1984) The classification and mechanisms of spontaneous abortion. Perspect Pediatr Pathol 8:269–287PubMedGoogle Scholar
  57. Rushton DI (1987) Pathology of abortion. In: Fox H (ed) Haines and Taylor: Obstetrical and gynaecological pathology, 3rd edn. Churchill Livingstone, Edinburgh, pp 1117–1148Google Scholar
  58. Rushton DI (1988) Placental pathology in spontaneous miscarriage. In: Beard RW, Sharp F (eds) Early pregnancy loss: mechanisms and treatment. Springer-Verlag, London, pp 149–157Google Scholar
  59. Russell P (1987) Infections of the placental villi (villitis). In: Fox H (ed) Haines and Taylor: Obstetrical and gynaecological pathology, 3rd edn. Churchill Livingstone, Edinburgh, pp 1014–1029sGoogle Scholar
  60. Schaaps JP, Hustin J (1988) Dynamic imaging of the utero-placental border in the first trimester of human pregnancy. Trophoblast Res 3:37–45Google Scholar
  61. Schoonmaker JN, Lavellin DW, Lunt B, McGregor GA (1989) Bacteria and inflammatory cells reduce chorioamniotic membrane integrity and tensile strength. Obstet Gynecol 74:590–596PubMedGoogle Scholar
  62. Surti U, Szulman AE, Wagner K, Leppert M, O’Brien SJ (1986) Tetraploid partial hydatidiform moles: two cases with a triple paternal contribution and a 92,XXXY karotype. Hum Genet 72:15–21Google Scholar
  63. Teng NMM, Ballon SC (1984) Partial hydatidiform mole with diploid karotype: report of three cases. Am J Obstet Gynecol 150:961–965PubMedGoogle Scholar
  64. Treffers PE (1990) Uterine causes of early pregnancy failure - a critical evaluation. In: Huisjes HJ, Lind T (eds) Early pregnancy failure. Churchill Livingstone, Edinburgh, pp 114–147Google Scholar
  65. van Oven MW, Schoots CJF, Oosterhuis JW, Klef JF, Dam-Metring A, Huisjes HJ (1989) The use of DNA flow cytometry in the diagnosis of triploidy in human abortions. Hum Pathol 20:238–240PubMedCrossRefGoogle Scholar

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© Springer-Verlag London Limited 1992

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  • H. Fox

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