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Abortion, Placentas of Trisomies, and Immunological Considerations of Recurrent Reproductive Failure

  • Chapter
Pathology of the Human Placenta

Abstract

For the present discussions, an abortion or miscarriage is designated a conceptus that is expelled before the 20th week of gestation. That is important to state at the outset, as the pathological features of failed pregnancies differ markedly in specimens obtained later during gestation. In the United States terminations before 20 weeks constitute abortions; later gestations are premature deliveries. A pregnancy of 20 weeks is legally at the dividing line; it is considered a gestation either with an embryo (that may be treated as a surgical specimen) or a fetus, whose examination constitutes an autopsy. The terminology employed in publications and statistics differs widely and is not the same in different countries. For instance, Vogel (1969, 1992) considered an abortion an expelled fetus of less than 1,000g. He differentiated between embryonic and fetal (15–28 weeks) abortion. Legal viability is frequently considered to be attained only at 28 weeks’ gestation when the fetus has attained approximately 1,000 g in weight; but that is not so in the United States. Byrne et al. (1985), in a study of early fetal deaths, considered all specimens less than 28 weeks’ gestation. For these reasons it is difficult to place in context with current terminology the studies of Vogel (1969, 1992). Most spontaneous abortions occur before 12 weeks’ gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks’ gestation. Thereafter, between 20 and 30 weeks, another type of premature spontaneous termination becomes prevalent—that due to ascending infection. These are fundamentally different processes with vastly different pathological findings.

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  1. University Medical Center, University of California, San Diego, 92103-8321, San Diego, California, USA

    Kurt Benirschke MD (Professor of Pathology and Reproductive Medicine)

  2. Institut für Anatomie der Medizinischen Fakultät, Rheinisch-Westfälische Technische Hochschule Aachen, 52057, Aachen, Germany

    Professor Dr. med. Peter Kaufmann

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Benirschke, K., Kaufmann, P. (1995). Abortion, Placentas of Trisomies, and Immunological Considerations of Recurrent Reproductive Failure. In: Pathology of the Human Placenta. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4196-4_21

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