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The role of trophoblast dysfunction in the aetiology of miscarriage
Author(s) -
Johnson M. R.,
Riddle A. F.,
Grudzinskas J. G.,
Sharma V.,
Collins W. P.,
Nicolaides K. H.
Publication year - 1993
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1993.tb12979.x
Subject(s) - miscarriage , fetus , gestation , obstetrics , pregnancy associated plasma protein a , medicine , pregnancy , gestational sac , trophoblast , products of conception , gestational age , embryo transfer , gynecology , placenta , biology , first trimester , genetics
Objective To investigate the endocrine changes associated with spontaneous miscarriage after fetal heart activity has been demonstrated. Design Prospective study during the first trimester of pregnancy comparing the circulating levels of human chorionic gonadotrophin (hCG), Schwangerschaft protein 1 (SP‐1), pregnancy‐associated plasma protein A (PAPP‐A), oestradiol (E 2 ), and progesterone (P), and fetal growth (crown‐rump length [CRL] and gestational sac volume [GSV]) in women who miscarried after the identification of fetal heart activity with those of normal singleton and twin pregnancies achieved following in vitro fertilisation (IVF) and embryo transfer (ET). Setting The Assisted Conception Unit of King's College Hospital, London. Subjects Nine women who miscarried after demonstration of fetal heart activity, 52 normal singleton and 22 normal twin pregnancies. Interventions Weekly blood tests and ultrasound assessments of CRL and GSV. Results Four fetuses (all singleton) died between 9 and 12 weeks gestation (Group 1), and seven (three singleton and two twin) died between 16 and 20 weeks gestation (Group 2). In Group 1, both fetal growth and placental function, as assessed by serial measurements of CRL and GSV, and of serum levels of PAPP‐A, SP‐1 and hCG respectively, were reduced before fetal death. In Group 2, while fetal growth was maintained in all but one case, placental function was reduced in 4 of 5 women. Conclusion These findings suggest that there may be a relationship between trophoblast dysfunction and some forms of miscarriage. Furthermore, the pattern of the reduction in the circulating levels of the placental proteins in later miscarriages suggests that the function of specific cell types may be impaired.