Comprehensive molecular and morphological study of abortion material in missed abortion of the first trimester

Abstract

BACKGROUND: Missed abortion is the main cause of reproductive loss in the first trimester, and genetic causes come first in the etiology of this disease. The immunological aspects of the mother-fetus system are currently widely discussed. In this regard, the study of the immunological relationship between the mothers body and the fetus in missed abortion, depending on the chorion karyotype, as well as after suffering reproductive loss, is a topical task, as it can optimize the methods of examining patients with missed abortion and identify factors that contribute to the development of recurrent miscarriage. AIM: The aim of this study was to investigate the morphological and immunohistochemical characteristics of abortion material in missed abortion, depending on the presence of chorionic chromosomal abnormalities and the patients history of reproductive losses. MATERIALS AND METHODS: We performed a comprehensive morphological and immunohistochemical study (CD56, HLA-DR-II) of abortion material in 273 cases of missed abortion. Group 1 consisted of patients with different variants of chorionic chromosomal abnormalities (n = 169); group 2 included subjects with a normal karyotype of the chorion (n = 104). The data analysis was carried out taking into account the anamnesis of patients, depending on the presence of reproductive losses. RESULTS: We revealed the morphological features of the abortion material in missed abortion in cases with chromosomal abnormalities of the chorion: pronounced edema, sclerosis, necrosis of chorionic villi, more pronounced inflammatory changes in the form of moderate and severe macrophage infiltration of the decidual tissue and endometrium, and accumulations of leukocytes as microabscesses. It has been proven that the severity of inflammatory changes in abortuses depends only on the chorion karyotype and does not depend on either the duration of the presence of an unviable fetal egg in the uterine cavity, or the patients history of reproductive losses. It was shown that the CD56 and HLA-DR-II expressions in the abortion material depend on the patients history of reproductive losses, regardless of the chorion karyotype. CONCLUSIONS: In patients with an unburdened obstetric and gynecological history in the first missed abortion, it is advisable only to determine the chorion karyotype in order to identify the cause of missed abortion. The immunohistochemical study of the abortion material with the determination of the CD56 and HLA-DR-II expressions is important in repeated missed abortions, regardless of the chorion karyotype.