Abortion, Placentas of Trisomies, and Immunological Considerations of Recurrent Reproductive Failure

  • Kurt Benirschke
  • Peter Kaufmann


For the present discussions, “abortion” (miscarriage) is designated a conceptus that is expelled before the 20th week of gestation. In the United States, a gestation of 20 weeks is legally the dividing line between a pregnancy with an “embryo” (that may be treated as a surgical specimen) and a “fetus ” whose examination constitutes an autopsy. The terminology differs in many countries. Often “legal viability” is considered to be attained only at 28 weeks of gestation (approximately 1,000 gm fetal weight). For instance, Byrne et al. (1985), in a study of early fetal deaths, considered all specimens less than 28 weeks’ gestation. The study of Vogel (1969), who spoke of embryonic and fetal abortions, is difficult to place in context with current terminology, as used in the United States.


Spontaneous Abortion Hypertonic Saline Recurrent Spontaneous Abortion Hydatidiform Mole Legal Abortion 


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  1. Abaci, F., and Aterman, K.: Changes of the placenta and embryo in early spontaneous abortion. Am. J. Obstet. Gynecol. 102:252–263, 1968.PubMedGoogle Scholar
  2. Alvarez, H.: Diagnosis of hydatidiform mole by transabdominal placental biopsy. Am. J. Obstet. Gynecol. 95:538–541, 1966.PubMedGoogle Scholar
  3. Anderson, A.B.M., and Turnbull, A.C.: Changes in amniotic fluid, serum and urine following the intra-amniotic injection of hypertonic saline. Acta Obstet. Gynecol. Scand. 47:1–21, 1968.CrossRefGoogle Scholar
  4. Anonymous: Anshan department of obstetrics and gynecology: fetal sex prediction by sex chromatin of chorionic villi cells during early pregnancy. Chin. Med. J. 1:117–126, 1975.Google Scholar
  5. Anonymous: Abortion USA. Lancet 1:879–880, 1989.Google Scholar
  6. Antonarakis, S.E.: Diagnosis of genetic disorders at the DNA level. N. Engl. J. Med. 320:153–163, 1989.PubMedCrossRefGoogle Scholar
  7. Ayers, L.R., Drosman, S., and Saltzstein, S.L.: Iatrogenic paracervical implantation of fetal tissue during therapeutic abortion: a case report. Obstet. Gynecol. 37:755–760, 1971.PubMedGoogle Scholar
  8. Babaknia, A., Parmley, T.H., Burkman, R.T., Atienza, M.F., and King, T.M.: Placental histopathology of midtrimester termination. Obstet. Gynecol. 53:583–586, 1979.PubMedGoogle Scholar
  9. Barela, A.I., Kleinman, G.E., Golditch, I.M., Menke, D.J., Hogge, W.A., and Golbus, M.S.: Septic shock with renal failure after chorionic villus sampling. Am. J. Obstet. Gynecol. 154:1100–1102, 1986.PubMedGoogle Scholar
  10. Beer, A.E., and Billingham, R.E.: The Immunobiology of Mammalian Reproduction. Prentice Hall, Engle-wood Cliffs, N.J., 1976.Google Scholar
  11. Bengtsson, L.P., and Stormby, N.: The effect of intraam-niotic injection of hypertonic sodium chloride in human mid-pregnancy. Gynecol. Scand. 41:115–123, 1962.CrossRefGoogle Scholar
  12. Besley, G.T.N., Ferguson-Smith, M.E., Frew, C., Morris, A., and Gilmore, D.H.: First trimester diagnosis of Gaucher disease in a fetus with trisomy 21. Prenat. Diagn. 8:471–474, 1988.PubMedCrossRefGoogle Scholar
  13. Bogart, M.H., Pandian, M.R., and Jones, O.W.: Abnormal maternal serum chorionic gonadotropin levels in pregnancies with fetal chromosome abnormalities. Prenat. Diagn. 7:623–630, 1987.PubMedCrossRefGoogle Scholar
  14. Bogart, M.H., Golbus, M.S., Sorg, N.D., and Jones, O.W.: Human chorionic gonadotropin levels in pregnancies with aneuploid fetuses. Prenat. Diagn. 9: 379–384, 1989.PubMedCrossRefGoogle Scholar
  15. Bose, R., Cheng, H., Sabbadini, E., McCoshen, J., Mahadevan, M.M., and Fleetham, J.: Purified human early pregnancy factor from preimplantation embryo possesses immunosuppressive properties. Am. J. Obstet. Gynecol. 160:954–960, 1989.PubMedCrossRefGoogle Scholar
  16. Boue, J.G., and Boue, A.: Fréquence des aberrations chromosomiques dans les avortements spontanés humains. C. R. Acad. Sci. Paris 269:283–288, 1969.Google Scholar
  17. Brambati, B., and Varotto, F.: Infection and chorionic villus sampling. Lancet 2:609, 1985.CrossRefGoogle Scholar
  18. Breed, A., Mantingh, A., Govaerts, L., Booger, A., Anders, G., and Laurini, R.: Abnormal karyotype in the chorion, not confirmed in a subsequently aborted fetus. Prenat. Diagn. 6:375–377, 1986.PubMedCrossRefGoogle Scholar
  19. Bruyère, H.J., Arya, S., Kozel, J.S., Gilbert, E.F., Fitzgerald, J.M., Reynolds, J.F., Lewin, S.O., and Opitz, J.M.: The value of examining spontaneously abortedEiston, C.W.: Cellular reaction to choriocarcinoma. J. Pathol. 97:261–268, 1969.CrossRefGoogle Scholar
  20. Byrne, J., Warburton, D., Kline, J., Blanc, W., and Stein, Z.: Morphology of early fetal deaths and their chromosomal characteristics. Teratology 32:297–315, 1985.PubMedCrossRefGoogle Scholar
  21. Carr, D.H.: Chromosomal studies in spontaneous abortions. Obstet. Gynecol. 26:308–326, 1965.PubMedGoogle Scholar
  22. Cashner, K.A., Christopher, C.R., and Dysert, G.A.: Spontaneous fetal loss after demonstration of a live fetus in the first trimester. Obstet. Gynecol. 70:827–830, 1987.PubMedGoogle Scholar
  23. Castle, D., and Bernstein, R.: Cytogenetic analysis of 688 couples experiencing multiple spontaneous abortions. Am. J. Med. Genet. 29:549–556, 1988.PubMedCrossRefGoogle Scholar
  24. Cates, W., Ory, H.W., Rochat, R.W., and Tyler, C.W.: The intrauterine device and deaths from spontaneous abortion. N. Engl. J. Med. 295:1155–1159, 1976.PubMedCrossRefGoogle Scholar
  25. Cauchi, M.N., Koh, S.H., Tait, B., Mraz, G., Kloss, M., and Pepperell, R.J.: Immunogenetic studies in habitual abortion. Aust. N.Z. J. Obstet. Gynaecol. 27:52–54, 1987.PubMedCrossRefGoogle Scholar
  26. Cheung, S.W., Crane, J.P., Kyine, M., and Cui, M.Y.: Direct chromosome preparations from chorionic villi: a method for obtaining extended chromosomes and recognizing mosaicism confined to the placenta. Cytogenet. Cell Genet. 45:118–120, 1987.PubMedCrossRefGoogle Scholar
  27. Chieri, P.R., and Aldini, A.J.R.: Feasibility of placental biopsy in the second trimester for fetal diagnosis. Am. J. Obstet. Gynecol. 160:581–583, 1989.PubMedCrossRefGoogle Scholar
  28. Christie, J.L., Anderson, A.B.M., Turnbull, A.C., and Beck, J.S.: The human placenta and membranes: A histological and immunofluorescent study of the effects of intra-amniotic injection of hypertonic saline. J. Obstet. Gynaecol. Br. Commonw. 73:399–409, 1966.PubMedCrossRefGoogle Scholar
  29. Creasy, M.R., Crolla, J.A., and Alberman, E.D.: A cytogenetic study of human spontaneous abortions using banding techniques. Hum. Genet. 31:177–196, 1976.PubMedCrossRefGoogle Scholar
  30. Dawood, M.Y., and Jarrett, J.C.: Prolonged intrauterine retention of fetal bones after abortion causing infertility. Am. J. Obstet. Gynecol. 143:715–717, 1982.PubMedGoogle Scholar
  31. Eckman, T.R., and Carrow, L.A.: Placental lesions in spontaneous abortion. Am. J. Obstet. Gynecol. 84: 222–228, 1962.PubMedGoogle Scholar
  32. Edwards, R.G., Howe, C.W.S., and Johnson, M.H.: Immunobiology of Trophoblast. Cambridge University Press, Cambridge, 1975.Google Scholar
  33. Frigoletto, F.D., and Pokoly, T.B.: Electrolyte dynamics in hypertonic saline-induced abortions. Obstet. Gynecol. 38:647–652, 1971.PubMedGoogle Scholar
  34. Fujikura, T., Froehlich, L.A., and Driscoll, S.G.: A simplified anatomic classification of abortions. Am. J. Obstet. Gynecol. 95:902–905, 1966.PubMedGoogle Scholar
  35. Fujikura, T., Ezaki, K., and Nishimura, H.: Chorionic villi and syncytial sprouts in spontaneous and induced abortions. Am. J. Obstet. Gynecol. 110:547–555, 1971.PubMedGoogle Scholar
  36. Gant, N.F.: Recurrent spontaneous abortion. Supplement 21 to Williams Obstetrics. J.A. Pritchard, P.C. MacDonald, and N.F. Gant, eds., pp. 1–11. Appleton & Lange, East Norwalk, CN, 1989.Google Scholar
  37. Geisler, M., and Gropp, A.: Zur Methode der Züchtung von Abortmaterial für Chromosomenuntersuchungen. (Zugleich Mitteilung über die Beobachtung einer B-Trisomie bei Abortus). Geburtshilfe Frauenheilk. 27:113–126,1967.Google Scholar
  38. Geisler, M., Kleinebrecht, J., and Degenhardt, K.-H.: Histologische Analysen von triploiden Spontanaborten. Humangenetik 16:283–294, 1972.PubMedGoogle Scholar
  39. Gill, T.J., Wegmann, T.G., and Nisbet-Brown, E.: Immunoregulation and Fetal Survival. Oxford University Press, New York, 1987.Google Scholar
  40. Göcke, H., Schwanitz, G., Muradow, I., and Zerres, K.: Pathomorphologie und Genetik in der Frühschwangerschaft. Pathologe 6:249–259, 1985.PubMedGoogle Scholar
  41. Granat, M., Aloni, T., Makler, A., and Dar, H.: Autosomal translocation in an apparently normosper-mic male as a cause of habitual abortion. J. Reprod. Med. 26:52–55, 1981.PubMedGoogle Scholar
  42. Gustavii, B.: Studies on accidental intravascular injection in extra-amniotic saline induced abortion and a method for reducing this risk. J. Reprod. Med. 8: 70–74, 1972.PubMedGoogle Scholar
  43. Gustavii, B.: Studies on the mode of action of intra-amniotically and extra-amniotically injected hypertonic saline in therapeutic abortion. Acta Obstet. Gynecol. Scand. [Suppl.] 25:1–22, 1973.Google Scholar
  44. Gustavii, B., and Brunk, U.: A histological study of the effect on the placenta of intra-amniotically and extra-amniotically injected hypertonic saline in therapeutic abortion. Acta Obstet. Gynecol. Scand. 51:121–125, 1972.CrossRefGoogle Scholar
  45. Harrison, R.G., Jones, C.H., and Jones, E.P.: A pathological presomite human embryo. J. Pathol. Bacteriol. 92:583–584, 1966.PubMedCrossRefGoogle Scholar
  46. Hassold, T., Chen, N., Funkhouser, J., Jooss, T., Manuel, B., Matsuura, J., Matsuyama, A., Wilson, C., Yamana, J.A., and Jacobs, P.A.: A cytogenetic study of 1000 spontaneous abortions. Ann. Hum. Genet. 44:151–178, 1980.PubMedCrossRefGoogle Scholar
  47. Hecht, F.: The placenta in trisomy 18 syndrome: report of 2 cases. Obstet. Gynecol. 22:147–148, 1963.PubMedGoogle Scholar
  48. Herbst, R., and Multier, A.-M.: Structures pathologiques du placenta examinées au microscope électronique: premières observations des villosités de l’oef abortif humain. Gynécol. Obstet. (Paris) 70:369–376, 1971.Google Scholar
  49. Heritage, D.W., English, S.C., Young, R.B., and Chen, A.T.L.: Cytogenetics of recurrent abortions. Fertil. Steril. 29:414–417, 1978.PubMedGoogle Scholar
  50. Hern, W.M.: Correlation of fetal age and measurements between 10 and 26 weeks of gestation. Obstet. Gynecol. 63:26–32, 1984.PubMedGoogle Scholar
  51. Hertig, A.T., and Sheldon, W.H.: Minimal criteria required to prove prima facie case of traumatic abortion or miscarriage: an analysis of 1000 spontaneous abortions. Ann. Surg. 117:596–606, 1943.PubMedCrossRefGoogle Scholar
  52. Hertig, A.T., Rock, J., Adams, E.C., and Menkin, M.C.: Thirty-four fertilized human ova, good, bad and indifferent, recovered from 210 women of known fertility: a study of biologic wastage in early human pregnancy. Pediatrics 23:202–211, 1959.PubMedGoogle Scholar
  53. Hertz-Picciotto, I., and Samuels, S.J.: Incidence of early loss of pregnancy. N. Engl. J. Med. 319:1483–1484, 1988.PubMedCrossRefGoogle Scholar
  54. Honoré, L.H., Dill, E.I, and Poland, B.J.: The association of hydatidiform mole and trisomy 2. Obstet. Gynecol. 43:232–237, 1974.PubMedGoogle Scholar
  55. Honoré, L.H., Dill, F.J., and Poland, B.J.: Placental morphology in spontaneous humans abortuses with normal and abnormal karyotypes. Teratology 14:151–166, 1976.PubMedCrossRefGoogle Scholar
  56. Honoré, L.H., Lin, C.C., andBamforth, J.S.: Spontaneous abortion with uncommon forms of trisomy: a clinicopathologic study of fifteen cases. (Abstract P41.) Five cases of trisomy 15 in first trimester spontaneous abortion: gross and microscopic pathology. (Abstract P42.) Teratology 37:458–459, 1989.Google Scholar
  57. Huber, C.P., Melin, J.R., and Vellios, E.: Changes in chorionic tissue of aborted pregnancy. Am. J. Obstet. Gynecol. 73:569–578, 1957.PubMedGoogle Scholar
  58. Hustin, J., Schaaps, J.P., and Lambotte, R.: Anatomical studies of the utero-placental vascularization in the first trimester of pregnancy. Trophoblast Res. 3:49–67, 1988.Google Scholar
  59. Jacobs, P.A., Szulman, A.E., Funkhouser, J., Matsuura, J.S., and Wilson, C.C.: Human triploidy: relationship between parental origin of the additional haploid complement and development of partial hydatidiform mole. Ann. Hum. Genet. 46:223–231, 1982.PubMedCrossRefGoogle Scholar
  60. Jaffin, H., Kerenyi, T., and Wood, E.C.: Termination of missed abortion and the induction of labor in mid-trimester pregnancy. Am. J. Obstet. Gynecol. 84: 602–608, 1962.PubMedGoogle Scholar
  61. Jewett, J.E.: Two deaths from mid-trimester abortion. N. Engl. J. Med. 288:47–48, 1973.PubMedCrossRefGoogle Scholar
  62. Johnson, P.M., Chia, K.V., Hart, C.A., Griffith, H.B., and Francis, W.J.A.: Trophoblast membrane infusion for unexplained recurrent miscarriage. Br. J. Obstet. Gynaecol. 95:342–347, 1988.PubMedCrossRefGoogle Scholar
  63. Jurkovic, I., and Muzelak, R.: Frequency of pathologic changes in the young human chorion in therapeutic abortions of normal pregnancies: a report of 500 cases studied histologically. Am. J. Obstet. Gynecol. 108: 382–386, 1970.PubMedGoogle Scholar
  64. Jurukovski, J.N.: Complications following legal abortions. Proc. R. Soc. Med. 62:830–831, 1969.PubMedGoogle Scholar
  65. Kaali, S.G., Szigetvari, I.A., and Bartfai, G.S.: The frequency and management of uterine perforations during first-trimester abortions. Am. J. Obstet. Gynecol. 161:406–408, 1989.PubMedCrossRefGoogle Scholar
  66. Kaeser, O.: Studien an menschlichen Aborteiern mit besonderer Berücksichtigung der frühen Fehlbildungen und ihrer Ursachen. Schweiz. Med. Wochenschr. 79:509–515; 780–785; 803–805; 1050–1056; 1979–1084, 1949.Google Scholar
  67. Kaffe, S., Benn, P.A., and Hsu, L.Y.F.: Fetal blood sampling in investigation of chromosome mosaicism in amniotic fluid cell culture. Lancet 2:284, 1988.PubMedCrossRefGoogle Scholar
  68. Kajii, T., Ferner, A., Niikawa, N., Takahara, H., Ohama, K., and Avirachan, S.: Anatomic and chromosomal anomalies in 639 spontaneous abortuses. Hum. Genet. 55:87–98, 1980.PubMedCrossRefGoogle Scholar
  69. Kalousek, D.K.: Anatomic and chromosome anomalies in specimens of early spontaneous abortion—7 year experience. Birth Defects 23:153–168, 1987.PubMedGoogle Scholar
  70. Kalousek, D.K., and Dill, F.J.: Chromosomal mosaicism confined to the placenta in human conceptions. Science 221:665–667, 1983.PubMedCrossRefGoogle Scholar
  71. Kalousek, D., and McGillivray, B.: Confined placental mosaicism and intrauterine survival of trisomy 13 and 18. Am. J. Hum. Genet. 4LA278, 1987 (abstract 828).Google Scholar
  72. Kalousek, D.K., Barrett, I.J., and McGillivray, B.C.: Placental mosaicism and intrauterine survival of trisomies 13 and 18. Am. J. Hum. Genet. 44:338–343, 1989.PubMedGoogle Scholar
  73. Kazy, Z., Rozovsky, I.S., and Bakharev, V.A.: Chorion biopsy in early pregnancy: a method for early prenatal diagnosis for inherited disorders. Prenat. Diagn. 2:39–45, 1982.CrossRefGoogle Scholar
  74. Kellokumpu-Lehtinen, P., and Pelliniemi, L.J.: Sex ratio of human conceptuses. Obstet. Gynecol. 64: 220–222, 1984.PubMedGoogle Scholar
  75. Kirby, D.R.S., McWhirter, K.G., Teitelbaum, M.S., and Darlington, C.D.: A possible immunological influence on sex ratio. Lancet 2:139–140, 1967.PubMedCrossRefGoogle Scholar
  76. Knoth, M., and Larsen, J.E.: Ultrastructure of a human implantation site. Acta Obstet. Gynecol. Scand. 51: 385–393, 1972.CrossRefGoogle Scholar
  77. Kouvalainen, K., and Österlund, K.: Placental weights in Down’s syndrome. Ann. Med. Exp. Fenn. 45:320–322, 1967.PubMedGoogle Scholar
  78. Kovacs, B.W., Shahbahrami, B., and Comings, D.E.: Studies of human germinal mutations by deoxyribonucleic acid hybridization. Am. J. Obstet. Gynecol. 160:798–804, 1989.PubMedCrossRefGoogle Scholar
  79. Krawczun, M.S., Jenkins, E.C., Masia, A., Kunaporn, S., Stark, S.L., Duncan, C.J., Sklower, S.L., and Rudelli, R.D.: Chromosomal abnormalities in amniotic fluid cell cultures: a comparison of apparent pseudomosaicism in Chang and RPMI-1640 media. Clin. Genet. 35:139–145, 1989.PubMedCrossRefGoogle Scholar
  80. Kubatova, A., and Trnka, V.: Induced abortions of 8 to 12 weeks pregnancy: evaluation of methods and histological findings in decidua and chorionic villi. Acta Univ. Carol. Med. (Prague) 13:483–491, 1967.Google Scholar
  81. Kulazenko, V.P., and Kulazenko, L.G.: Pathomor-phological changes in an early spontaneous abortus with triploidy (69,XXX). Hum. Genet. 32:211–215, 1976.PubMedCrossRefGoogle Scholar
  82. Kuliev, A.M.: Cytogenetic investigation of spontaneous abortions. Humangenetik 12:275–283, 1971.PubMedCrossRefGoogle Scholar
  83. Kundsin, R.B., Falk, L., Hertig, A.T., and Hörne, H.W.: Acyclovir treatment of twelve unexplained infertile couples. Int. J. Fertil. 32:200–204, 1987.PubMedGoogle Scholar
  84. Ladefoged, C.: Hydrop degeneration: a histopathologi-cal investigation of 260 early abortions. Acta Obstet. Gynecol. Scand. 59:509–512, 1980.PubMedCrossRefGoogle Scholar
  85. Lawson, H.W., Atrash, H.K., and Franks, A.L.: Fatal pulmonary embolism during legal induced abortion in the United States from 1972 to 1985. Am. J. Obstet. Gynecol. 162:986–990, 1990.PubMedCrossRefGoogle Scholar
  86. Lichtig, C., Korat, A., Deutch, M., and Brandes, J.M.: Decidual vascular changes in early pregnancy as a marker for intrauterine pregnancy. Am. J. Clin. Pathol. 90:284–288, 1988.PubMedGoogle Scholar
  87. Lippman, A., Vekemans, M.J.J., and Perry, T.B.: Fetal mortality at the time of chorionic villi sampling. Hum. Genet. 68:337–339, 1984.PubMedCrossRefGoogle Scholar
  88. Luckett, W.P.: The development of the yolk sac during the first three weeks of gestation in the human and rhesus monkey. Anat. Rec. 172:358, 1972.Google Scholar
  89. Magenis, R.E.: On the origin of chromosomal anomaly. Am. J. Hum. Genet. 42:529–533, 1988.PubMedGoogle Scholar
  90. Manabe, Y., Okamura, H., and Yoshida, Y.: Bougie-induced abortion at mid-pregnancy and placental function: histological and histochemical study of the placenta. Endokrinologie 57:389–394, 1971.PubMedGoogle Scholar
  91. Marini, A., Suma, V., Baccichetti, C., and Lenzini, E.: A case of septic miscarriage, a probable complication of chorion villus sampling. Prenat. Diagn. 8:399–400, 1988.PubMedCrossRefGoogle Scholar
  92. Matayoshi, K., Yoshida, K., Soma, H., Miyabara, S., and Okamoto, N.: Placental pathology associated with chromosomal anomalies of the human neonate: a survey of seven cases. Congen. Anom. (Japan) 17:507–512, 1977.Google Scholar
  93. Mclntyre, J.A., Faulk, W.P., Nichols-Johnson, V.R., and Taylor, C.G.: Immunologic testing and immunotherapy in recurrent spontaneous abortion. Obstet. Gynecol. 67:169–174, 1986.CrossRefGoogle Scholar
  94. McLean, J.M.: Early embryo loss. Lancet 1:1033–1034, 1987.PubMedCrossRefGoogle Scholar
  95. Mennuti, M.X, Jingeleski, S., Schwarz, R.H., and Mellman, W.J.: An evaluation of cytogenetic analysis as a primary tool in the assessment of recurrent pregnancy wastage. Obstet. Gynecol. 52:308–313, 1978.PubMedGoogle Scholar
  96. Michel, M., Underwood, J., Clark, D.A., Mowbray, J.F., and Beard, R.W.: Histologic and immunologic study of uterine biopsy tissue of women with incipient abortion. Am. J. Obstet. Gynecol. 161:409–414, 1989.PubMedCrossRefGoogle Scholar
  97. Miller, J.F., Williamson, E., Glue, J., Gordon, Y.B., Grudzinskas, J.G., and Sykes, A.: Fetal loss after implantation: a prospective study. Lancet 2:554–556, 1980.PubMedCrossRefGoogle Scholar
  98. Mills, J.L., Simpson, J.L., Driscoll, S.G., Jovanovic-Peterson, L., van Allen, M., Aarons, J.H., Metzger, B., Bieber, E.R., Knopp, R.H., Holmes, L.B., Peterson, C.M., Withiam-Wilson, M., Brown, Z., Ober, C., Harley, E., MacPherson, T.A., Duckies, A., Mueller-Heubach, E. and National Institute of Child Health: Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. N. Engl. J. Med. 319:1617–1623, 1988.PubMedCrossRefGoogle Scholar
  99. Moen, D.W., Werner, J.K., and Bersu, E.T.: Analysis of gross anatomical variations in human triploidy. Am. J. Med. Genet. 18:345–356, 1984.PubMedCrossRefGoogle Scholar
  100. Monrozies, M.: La gravité actuelle de l’avortement provoqué. Gynécol. Obstet. (Paris) 70:79–94, 1971.Google Scholar
  101. Moore, K.L.: The Developing Human: Clinically Oriented Embryology. 3rd Ed. W.B. Saunders, Philadelphia, 1982.Google Scholar
  102. Mostello, D.J., Bofinger, M.K., and Siddiqi, T.A.: Spontaneous resolution of fetal cystic hygroma and hydrops in Turner syndrome. Obstet. Gynecol. 73: 862–865, 1989.PubMedGoogle Scholar
  103. Mowbray, J.F., Gibbings, C., Liddell, H., Reginald, P.W., Underwood, J.L., and Beard, R.W.: Controlled trial of treatment of recurrent spontaneous abortion by immunisation with paternal cells. Lancet 1:941–944, 1985.PubMedCrossRefGoogle Scholar
  104. Muggah, H.F., Dalton, M.E., and Hunter, A.G.W.: Chorionic villus sampling followed by genetic amniocentesis and septic shock. Lancet 1:867–868, 1987.PubMedCrossRefGoogle Scholar
  105. Neu, R.L., Entes, K., and Bannerman, R.M.: Chromosome analysis in cases with repeated spontaneous abortions. Obstet. Gynecol. 53:373–375, 1979.PubMedGoogle Scholar
  106. Nishimura, H., Takano, K., Tanimura, T., and Yasuda, M.: Normal and abnormal development of human embryos: first report of the analysis of 1,213 intact embryos. Teratology 1:281–290, 1968.PubMedCrossRefGoogle Scholar
  107. Novak, R., Agamanolis, D., Dasu, S., Igel, H., Platt, M., Robinson, H., and Shehata, B.: Histologie analysis of placental tissue in first trimester abortions. Pediatr. Pathol. 8:477–482, 1988.PubMedCrossRefGoogle Scholar
  108. Olding, L., Benirschke, K., and Oldstone, M.B.A.: Inhibition of mitosis of lymphocytes from human adults by lymphocytes from newborns. Clin. Immun. Immunopathol. 3:79–89, 1974.CrossRefGoogle Scholar
  109. Ornoy, A., Kohn, G., Zur, Z.B., Weinstein, D., and Cohen, M.M.: Triploidy in human abortions. Teratology 18:315–320, 1978.PubMedCrossRefGoogle Scholar
  110. Ornoy, A., Salamon-Arnon, J., Ben-Zur, Z., and Kohn, G.: Placental findings in spontaneous abortions and stillbirths. Teratology 24:243–252, 1981.PubMedCrossRefGoogle Scholar
  111. Palomaki, J.F., and Little, A.B.: Surgical management of abortion. N. Engl. J. Med. 287:752–754, 1972.PubMedCrossRefGoogle Scholar
  112. Philippe, E.: Pathologie Foeto-Placentaire. Masson, Paris, 1986.Google Scholar
  113. Philippe, E., and Boue, E.: Le placenta des aberrations chromosomiques létales. Ann. Anat. Pathol. (Paris) 14:249–266, 1969.Google Scholar
  114. Portnoi, M.-F., Joye, N., van den Akker, J., Morlier, G., and Taillemite, J.-L.: Karyotypes of 1142 couples with recurrent abortion. Obstet. Gynecol. 72:31–34,1988.PubMedGoogle Scholar
  115. Pozniak, M.A., Cullenward, M.J., Zickuhr, D., and Curet, L.B.: Venous lake bleeding: A complication of chorionic villous sampling. J. Ultrasound Med. 7:297–299, 1988.PubMedGoogle Scholar
  116. Pridjian, G., and Moawad, A.H.: Missed abortion: still appropriate terminology? Am. J. Obstet. Gynecol. 161:261–262, 1989.PubMedCrossRefGoogle Scholar
  117. Rehder, H., and Gropp, A.: Triploidie als Ursache fötoplacentarer Fehlbildung bei Abortus. Verh. Dtsch. Ges. Pathol. 55:525–529, 1971.PubMedGoogle Scholar
  118. Rhoads, G.G., Jackson, L.G., Schlesselman, S.E., de la Cruz, F.F., Desnick, R.J., Golbus, M.S., Ledbetter, D.H., Lubs, H.A., Mahoney, M.J., Pergament, E., Simpson, J.L., Carpenter, R.J., Elias, S., Ginsberg, N.A., Goldberg, J.D., Hobbins, J.C., Lynch, L., Shiono, P.H., Wapner, R.J., and Zachary, I.M.: The safety and efficacy of chorionic villus sampling for early prenatal diagnosis of cytogenetic abnormalities. N. Engl. J. Med. 320:609–617, 1989.PubMedCrossRefGoogle Scholar
  119. Rochelson, B., Kaplan, C., Guzman, E., Arato, M., Hansen, K., and Trunca, C.: A quantitative analysis of placental vasculature in the third-trimester fetus with autosomal trisomy. Obstet. Gynecol. 75:59–63, 1990.PubMedGoogle Scholar
  120. Rosenmann, A., Palti, Z., Segal, S., and Cohen, M.M.: Chromosomes in familial primary sterility and in couples with recurrent abortions and stillbirths. Isr. J. Med. Sci. 13:1131–1133, 1977.PubMedGoogle Scholar
  121. Sachs, E.S., Jahoda, M.G.J., van Hemel, J.O., Hoogeboom, A.J.M., and Sandkuyl, L.A.: Chromosome studies of 500 couples with two or more abortions. Obstet. Gynecol. 65:375–378, 1985.PubMedGoogle Scholar
  122. Sadovsky, A., and Laufer, A.: Placental changes in early spontaneous abortion. Obstet. Gynecol. 17:678–683, 1961.PubMedGoogle Scholar
  123. Salafia, C.M., and Burns, J.P.: The correlation of placental and decidual histology with karyotype and fetal viability. Teratology 39:478 (P37), 1989.Google Scholar
  124. Sasaki, M., Makino, S., Muramoto, J.-I., Ikeuchi, T., and Shimba, H.: A chromosome survey of induced abortuses in a Japanese population. Chromosoma 20:267–283, 1967.PubMedCrossRefGoogle Scholar
  125. Schaaps, J.P., and Hustin, J.: In vivo aspect of the maternal-trophoblastic border during the first trimester of gestation. Trophoblast Res. 3:39–48, 1988.Google Scholar
  126. Schulman, H., Kaiser, I.H., and Randolph, G.: Outpatient saline abortion. Obstet. Gynecol. 37:521–526, 1971.PubMedGoogle Scholar
  127. Schulze, B., Schlesinger, C., and Miller, K.: Chromosomal mosaicism confined to chorionic tissue. Prenat. Diagn. 7:451–453, 1987.PubMedCrossRefGoogle Scholar
  128. Scott, J.R., Rote, N.S., and Branch, D.W.: Immunologic aspects of recurrent abortion and fetal death. Obstet. Gynecol. 70:645–656, 1987.PubMedGoogle Scholar
  129. Segal, S., Ornoy, A., Bercovici, B., Antebi, S.O., and Polishuk, W.Z.: Placental pathology in midtrimester pregnancies interrupted by intra-amniotic injection of hypertonic urea. Br. J. Obstet. Gynaecol. 83:156–159, 1976.PubMedCrossRefGoogle Scholar
  130. Sehgal, N., Parr, M., and Haslett, E.: Clostridium infection after intra-amniotic hypertonic saline injection for induced abortion. J. Reprod. Med. 8:67–69, 1972.PubMedGoogle Scholar
  131. Seward, P.N., Ballard, C.A., and Ulene, A.L.: The effect of legal abortion on the rate of septic abortion at a large county hospital. Am. J. Obstet. Gynecol. 115: 335–338, 1973.PubMedGoogle Scholar
  132. Shepard, T.H., Fantel, A.G., and Fitzsimmons, J.: Congenital defect rates among spontaneous abortuses: twenty years of monitoring. Teratology 39:325–331, 1989a.PubMedCrossRefGoogle Scholar
  133. Shepard, T.H., Fitzsimmons, J.M., Fantel, A.G., and Pascoe-Mason, J.: Placental weights of normal and aneuploid early human fetuses. Teratology 39:481 (P54), 1989b.Google Scholar
  134. Shepard, T.H., Fitzsimmons, J.M., Fantel, A.G., and Pascoe-Mason, J.: Placental weights of normal and aneuploid early human fetuses. Pediatr. Pathol. 9: 425–431, 1989c.PubMedCrossRefGoogle Scholar
  135. Shettles, L.: The great preponderance of human males conceived. Am. J. Obstet. Gynecol. 89:130–133, 1964.PubMedGoogle Scholar
  136. Simpson, J.L., Meyers, C.M., Martin, A.O., Elias, S., and Ober, C.: Translocations are infrequent among couples having repeated spontaneous abortions but no other abnormal pregnancies. Fertil. Steril. 51:811–814, 1989.PubMedGoogle Scholar
  137. Singh, R.P., and Carr, D.H.: Anatomic findings in human abortions of known chromosomal constitution. Obstet. Gynecol. 29:806–818, 1967.PubMedGoogle Scholar
  138. Singh, R.P., and Carr, D.H.: Congenital anomalies in embryos with normal chromosomes. Biol. Neonat. 13:121–128,1968.PubMedCrossRefGoogle Scholar
  139. Steier, J.A., Sandvei, R., and Myking, O.L.: Human chorionic gonadotropin in early normal and pathological pregnancy: discordant levels in peripheral maternal blood and blood from the uterine and abdominal cavities. Am. J. Obstet. Gynecol. 154: 1091–1094, 1986.PubMedGoogle Scholar
  140. Stein, Z. A.: A woman’s age: childbearing and child rearing. Am. J. Epidemiol. 121:327–342, 1985.PubMedGoogle Scholar
  141. Steinberg, C.R., Berkowitz, R.L., Merkatz, I.R., and Roberts, R.B.: Fever and bacteremia associated with hypertonic saline abortion. Obstet. Gynecol. 39:673–678, 1972.PubMedGoogle Scholar
  142. Stewart, G.K., and Goldstein, R.J.: Therapeutic abortion in California. Effects on septic abortion and maternal mortality. Obstet. Gynecol. 37:510–514, 1971.PubMedGoogle Scholar
  143. Stioui, S., deSilvestris, M., Molinari, A., Stripparo, L., Ghisoni, L., and Simoni, G.: Trisomie 22 placenta in a case of severe intrauterine growth retardation. Pre-nat. Diagn. 9:673–676, 1989.Google Scholar
  144. Studdiford, W.E., and Douglas, G.W.: Placental bacteremia: a significant finding in septic abortion accompanied by vascular collapse. Am. J. Obstet. Gynecol. 71:842–858, 1956.PubMedGoogle Scholar
  145. Suter, P.E.N., Chatfield, W.R., and Kotonya, A.O.: The use of suction curettage in incomplete abortion. J. Obstet. Gynaecol. Br. Commonw. 77:464–466, 1970.PubMedCrossRefGoogle Scholar
  146. Tharapel, A.T., Elias, S., Shulman, L.P., Seely, L., Emerson, D.S., and Simpson, J.L.: Resorbed co-twin as an explanation for discrepant chorionic villus results: non-mosaic 47,XX, + 16 in villi (direct and culture) with normal (46,XX) amniotic fluid and neonatal blood. Prenat. Diagn. 9:467–472, 1989.PubMedCrossRefGoogle Scholar
  147. Turleau, C., Chavin-Colin, F., and de Grouchy, J.: Cytogenetic investigation in 413 couples with spontaneous abortions. Eur. J. Obstet. Gynecol. Reprod. Biol. 9:65–74, 1979.PubMedCrossRefGoogle Scholar
  148. Verjaal, M., Leschot, N.J., Wolf, H., and Treffers, P.E.: Karyotypic differences between cells from placenta and other fetal tissues. Prenat. Diagn. 7:343–348, 1987.PubMedCrossRefGoogle Scholar
  149. Verp, M.S., Rosinsky, B., Sheikh, Z., and Amarose, A.P.: Non-mosaic trisomy 16 confined to villi. Lancet 2:915–916, 1989.PubMedCrossRefGoogle Scholar
  150. Vogel, M.: Placentabefunde beim Abort: ein Beitrag zur Patho-Morphologie placentarer Entwicklungsstörungen. Virchows Arch. [A] 346:212–223, 1969.CrossRefGoogle Scholar
  151. Wade, R.V., and Young, S.R.: Analysis of fetal loss after transcervical chorionic villus sampling—A review of 719 patients. Am. J. Obstet. Gynecol. 161:513–519, 1989.PubMedCrossRefGoogle Scholar
  152. Wall, R.L., and Hertig, A.T.: Habitual abortion. Am. J. Obstet. Gynecol. 56:1127–1133, 1948.PubMedGoogle Scholar
  153. Ward, B.E., Henry, G.P., and Robinson, A.: Cytogenetic studies in 100 couples with recurrent spontaneous abortions. Am. J. Hum. Genet. 32:549–554, 1980.PubMedGoogle Scholar
  154. Wegmann, T.G., Gill, T.J., Cumming, C.D., and Nisbet-Brown, E., eds.: Immunology of Reproduction. Oxford University Press, New York, 1983.Google Scholar
  155. Wilcox, A.J., Weinberg, C.R., O’Connor, J.F., Baird, D.D., Schlatterer, J.P., Canfield, R.E., Armstrong, E.G., and Nisula, B.C.: Incidence of early loss of pregnancy. N. Engl. J. Med. 319:189–194, 1988.PubMedCrossRefGoogle Scholar
  156. Yamamoto, M., and Watanabe, G.: Epidemiology of gross chromosomal anomalies at early embryonic stage of pregnancy. Contrib. Epidemiol. Biostatist. 1:101–106, 1979.Google Scholar
  157. Zerres, K., Niesen, M., Schwanitz, G., and Hansmann, M.: Trisomie 22—Pränatale Befunde unterschiedlicher Entwicklungsstadien. Geburtshilfe Frauen-heilk. 48:720–723, 1988.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Kurt Benirschke
    • 1
    • 2
  • Peter Kaufmann
    • 3
  1. 1.Pathology and Reproductive MedicineUniversity of CaliforniaSan DiegoUSA
  2. 2.University Medical CenterSan DiegoUSA
  3. 3.Institut für Anatomie der Medizinischen Fakultät, Rheinisch-Westfälische TechnischeHochschule AachenAachenGermany

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