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Early embryonic demise: no evidence of abnormal spiral artery transformation or trophoblast invasion
Author(s) -
Ball E,
Robson SC,
Ayis S,
Lyall F,
Bulmer JN
Publication year - 2006
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.1926
Subject(s) - spiral artery , trophoblast , decidua , myometrium , miscarriage , biology , placenta , andrology , medicine , gestation , pregnancy , pathology , obstetrics , uterus , endocrinology , fetus , genetics
Invasion by extravillous trophoblast of uterine decidua and myometrium and the associated spiral artery ‘transformation’ are essential for the development of normal pregnancy. Small pilot studies of placental bed and basal plate tissues from miscarriages have suggested that impaired interstitial and endovascular trophoblast invasion may play a role in the pathogenesis of miscarriage. The hypothesis that early miscarriage is associated with reduced extravillous trophoblast invasion and spiral artery transformation was tested in a large series of placental bed biopsies containing decidua and myometrium and at least one spiral artery from early, karyotyped embryonic miscarriages (≤12 weeks' gestation; n = 50) dated from the last menstrual period and ultrasound scan dated normal pregnancies ( n = 78). Frozen sections were immunostained to demonstrate trophoblast (cytokeratin), myometrium and spiral artery medial smooth muscle (desmin), and endothelium (von Willebrand factor). Trophoblast invasion and individual features of spiral artery transformation were assessed histologically in spiral arteries of miscarriages ( n = 176) and controls ( n = 246) and analysed statistically using a logistic regression model. Trophoblast invasion of uterine tissues and spiral artery transformation did not differ between euploid and aneuploid early miscarriage and also did not differ significantly from normal pregnancy. These findings suggest that failed trophoblast invasion and spiral artery transformation do not have a pivotal role in the pathogenesis of early miscarriage. Copyright © 2006 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.