Spontaneous abortion
Abortion is termination of pregnancy in the first 28 weeks when the fetus is not yet viable. According to the nature of termination of pregnancy, abortion may be artificial and spontaneous.
While artificial abortion is performed either at a health care facility (medical abortion) or outside it (criminal abortion), spontaneous abortion occurs without any interventions. Recurrence of a spontaneous abortion more than 2 times is called recurrent abortion. Spontaneous abortion terminates between 10% and 20% of clinically diagnosed pregnancies.
The etiology of spontaneous abortion is diverse; it includes chromosomal and gene mutations, immunological factors, endocrine disorders, psychological factors, uterine malformations, infections, diabetes mellitus, systemic lupus erythematosus and other maternal somatic diseases, as well as various physical and chemical influences. At the same time, the cause of spontaneous abortion is often unclear.
A special role in the etiology of spontaneous abortions is played by chromosomal aberrations: autosomia, trisomy, monosomia, triploidy and tetraploidy. In the first weeks of pregnancy, most embryos with an aberrant karyotype die. Thus, at 6-7 weeks of gestation, anomalous karyotype is typical of 60-75% abortuses; at 12-17 weeks - of 20-25%; while at 17-28 weeks - only of 2-7%. In early pregnancy, any severe infectious disease of the mother (influenza, virus infection, lobar pneumonia, etc.) can cause an abortion. However, some microorganisms have a pronounced abortive effect, while not causing clinically pronounced “infectious” symptoms in the woman. These include rubella virus, listeria, cytomegalovirus, toxoplasma, campylobacter, HSV and Coxsackie virus.
Pathology. Morphological material obtained after spontaneous abortions for pathomorphological examination is very heterogeneous. It can be an entirely intact ovum, chorion villi or decidual tissue. However, more often fragments of decidual tissue and chorion villi are sent for examination. Microscopy of the material obtained D&C shows foci of necrosis of decidual tissue with pronounced neutrophil infiltration, blood clots in decidual blood vessels, hemorrhage foci of varying sizes, edematous and avascular chorion villi. The main objective of the study is to establish the fact of pregnancy, confirm the localization of pregnancy in the uterus, assess the approximate term of abortion according to the morphology of villi , and rule out trophoblastic disease.