Fetal Pathology in Second-Trimester Miscarriages

Abstract

Objective: We aimed to analyze, based upon autopsy, the main characteristics of miscarriages in the second trimester. Methods: We have processed the results of fetopathological investigations of 544 aborted fetuses resulting from 486 second-trimester miscarriages. Results: Malformation could be identified in 13.05% of all cases. In almost one third of the patients there was a positive history. In the cases having a malformation, expressed dominance of male fetuses could be observed. Among the fetopathologically identified malformations, 49 were isolated. The most common was the single umbilical artery (22.4%). In 1.3% of the cases a chromosome aberration was verified. Conclusion: Miscarriage in pregnancies complicated by a malformation occurs approximately 3 weeks earlier than in cases without a confirmed malformation. There is practically no difference between affected and unaffected miscarriages as far as the cumulative ratio of positive history is concerned. A single umbilical artery alone predisposes to miscarriage, while in association with other malformations it may result from chromosome aberration.

Single Umbilical Artery: Does Side Matter?

“…In addition, no significant differences were demonstrated with regard to rates of chromosomal abnormality or umbilical artery Doppler abnormality (table 4). Although the literature suggests that fetal loss is associated with an SUA [17], we did not find a difference between left and right AUA groups. Of note, of the pregnancies who did not terminate or deliver at their local facilities, 110 fetuses from the left AUA group and 82 fetuses from the right AUA group were available for outcome measures.…”

"Surveillance of Adverse Pregnancy Outcomes and their Causes: Theoretical Considerations"

“…For losses, about half of all biochemically verified implantations, mostly aneuploid and clinically unrecognized, fail to reach term [10,11]. With a high mortality, aneuploidy rates progressively decrease, so that of 544 second trimester miscarriages, only 1.3% were affected [12]. For stillbirths after 20 weeks, the best ascertained group, world rates range from under 5 to roughly 32 per 1000 births.…”

“…Early second trimester timing is also helpful. Studies can be initiated close to possible causative events, recall biases are reduced, late pregnancy confounders eliminated, and aneuploid confounders unrelated to apogens are greatly decreased by this time [12].…”