DECIDUAL AND PLACENTAL HISTOLOGIC-FINDINGS IN PATIENTS EXPERIENCING SPONTANEOUS-ABORTIONS IN RELATION TO PREGNANCY ORDER

PROBLEM: In investigating possible immunologic causes of miscarriage, we hypothesized a more frequent maternal immune response in placental tissue in women miscarrying their first pregnancy, compared to woman m iscarrying following at least one full-term delivery. METHOD OF STUDY: We reviewed the medical charts of 273 consecutive women who had treat ment for miscarriage. After application of the exclusion criteria, 32 patients were selected who had a full-term pregnancy outcome following the index miscarriage. The patients were divided into two groups base d on the pregnancy order of the index miscarriage. Group 1 (n=16) incl uded women who lost their first pregnancy. Group 2 (n=16) included wom en who miscarried a pregnancy after at least one full-term delivery. M iscarriage tissue was evaluated for placental and decidual histologic features of uteroplacental vasculopathy and chronic inflammation. RESU LTS: Lesions of chronic inflammatory and uteroplacental vasculopathy w ere generally more common in Group 1 as compared to Group 2, and the p resence of more than one of the histopathologic lesions was significan tly more frequent in Group 1 (37.5%, 6/16) than in Group 2 (0/16, P=.0 2, Fisher's Exact). CONCLUSIONS: This study demonstrates more frequent lesions of chronic inflammation and uteroplacental vasculopathy in mi scarriage patients with a first pregnancy loss, compared to those pati ents who have had a pregnancy loss following at least one full-term de livery.