Revista Chilena de Obstetricia y Ginecología (Jan 2003)
HISTOPATOLOGIA DEL ABORTO ESPONTANEO ENTRE 12 Y 22 SEMANAS
Abstract
Objetivos: Analizar los resultados histopatológicos encontrados en el aborto espontáneo entre 12 y 22 semanas de gestación y su relación con los correspondientes antecedentes obstétricos y clínicos, para determinar los factores causantes. Métodos: Se estudiaron retrospectivamente cuatrocientas seis pacientes con aborto espontáneo entre 12 y 22 semanas de gestación ocurridos durante 1 año. Se incluyeron cientonueve casos con estudio histopatológico de los anexos ovulares y/o del feto. El aborto se clasificó: a) según ultrasonografía en: aborto con feto vivo, aborto con muerte fetal y restos de aborto y b) según edad gestacional (semanas) en tres grupos: A) entre 12 y 14,6, B) entre 15 y 18,6 y C) entre 19 y 22. Se analizaron antecedentes ginecoobstétricos: aborto recurrente (pérdida reproductiva recurrente consecutiva), embarazo con dispositivo intrauterino y antecedentes clínicos del aborto: deprendimiento placentario, infección ovular y huevo roto. Los hallazgos histopatológicos se clasificaron en: 1) lesiones inflamatorias, 2) lesiones placentarias no inflamatorias, 3) síndromes malformativos, 4) hidrops fetal y 5) alteraciones placentarias involutivas. Resultados: Las cientonueve pacientes tuvieron las siguientes lesiones histológicas: Inflamatorias 56% (corioamnionitis 53,2%), funisitis 24,8%, perivellositis 21,1%, vellositis 3,7%, deciduitis 8,3% y síndrome de infección del saco amniótico: 13,9%). Síndromes malformativos: 11%. Placentarias no inflamatorias: 7,3%. Hidrops fetal: 4,6%. Existieron alteraciones involutivas en el 14,7% de los abortos y no se encontraron lesiones en el 10,1% de los casos. Se identificaron lesiones en el 75,2% de los abortos. Más frecuentes en los abortos con feto vivo 83,6%, en comparación con los restos de aborto 68,4% y con el aborto con muerte fetal 65,7%, pObjectives: To analyze the histophatological results found in the spontaneous abortion between 12 and 22 weeks of gestation and their relationship with the corresponding obstetrical and clinical data for determining their ethiology. Methods: Four hundred and six patients with spontaneous abortion between 12 and 22 weeks of gestation, during the course of one year, were studied retrospectively. Of these, one hundred and nine cases with histopathological study of the placenta and umbilical cord, and/or the fetus, were included in the study. The abortions were classified: a) according to ultrasonography of abortion with live fetus, abortion with fetal death and abortion remnants, and b) according to the gestational age (weeks), in thrree groups: a) between 12 and 14.6; b) between 15 and 18.6, and c) between 19 and 22. Gyneco-obstetrical data were analized: recurrent abortion (consecutive recurrent loss of reproductive capacity), pregnancy with intrauterine dispositive, and clinical data of the abortion: placental abruption, clinical chorioamnionitis and ovum with rupture of membranes. Histophatological findings were classified as: 1) inflammatory lesions; 2) non-inflammatory placental lesions, 3) malformation syndromes; 4) fetal hydrops; 5) involutive placental alterations. Results: The one hundred and nine patients presented the following histological lesions: Inflammatory, 56% (choroamninitis, 53.2%; funisitis, 24.8%; perivellositis, 21.1%; vellitis, 3.7%; deciduitis, 8.3% and amniotic sac infection syndrome, 13.9%. Malformation syndromes, 11%. Non-inflamatory placental, 7.3%. Fetal hydrops, 4.6%. There were involutive alterations in 14.7% of the abortions and no lesions were found in a 10.1% of the cases. Lesions were identified in a 75.2% of the abortion, more frequently in the abortions with a live fetus (83.6%) as compared to those with abortion remnants (68.4%) and to abortions with fetal death (65.7%, p< 0,05). Lesions found: According to gestational age: in group A (chorioamnionitis, 29.7%; perivellositis, 18.9%; malformation syndromes, 13.5%; in group B (chorioamnionitis 63.9%; funisitis, 33.3%; perivellositis, 22.2%), and in group C (chorioamnionitis, 66.7%; funisitis, 33.3%; amniotic sac infection syndrome, 25%). According to ultrasonography: with live fetus (inflammatory, for the most part); with fetal death (inflammatory, non-inflammatory placental, malformation syndromes). According to clinical and obstetrical data: Recurrent abortion (inflammatory, 21.4%; non-inflammatory placental, 21.4%; malformation syndromes, 14.3%). Abortion with IUD (inflammatory, 66.7%; malformation syndromes, 13.3%). Placental aburption (inflammatory, 54.5%; non-inflammatory placental, 45.5%). Clinical chorioamnionitis (inflammatory, 88.9%; non-inflammatory, 5.6%). Ovum with rupture of membranes (inflammatory lesions, 80.09%). Conclusions: Spontaneous abortion between 12 and 22 weeks presents a variety of histopathological lesions. Acute inflammatory lesions suggestive of ascending infection are the most frequent. Routinary examination of the placenta provides essential information about the causes of the abortion and allows a more efficient planning for a future pregnancy
