Gun Banu Dogan, Numanoglu Gamze, Ozdamar Sukru Oguz
Department of Pathology, Faculty of Medicine, Zonguldak Karaelmas University, Turkey.
Acta Obstet Gynecol Scand. 2006;85(4):402-6. doi: 10.1080/00016340500501731.
To determine whether adequate trophoblastic migration and maternal placental perfusion occurs in cases of early pregnancy loss, we compared vessels in elective abortion decidua with those in spontaneous abortion decidua.
Elective abortion decidua at 5-11 weeks (n = 40) were compared with spontaneous abortion decidua at 5-12 weeks (n = 25). Also normal late secretory endometrial biopsy specimens (n = 10) were examined. The cross-sections of veins and arteries were counted in 25 elective and 15 spontaneous abortion materials. The number of the veins that contain trophoblastic fragments and the number of the spiral arteries converted by trophoblasts were determined. Statistical significance by Mann-Whitney U and Spearman's correlation test was p < 0.05.
All sets of decidua had dilated veins, but no secretory endometrium did. The ratio of converted spiral arteries to nonconverted arteries was much more in elective abortion decidua (113/938, 12.04%) than in spontaneous abortion decidua (11/511, 2.15%) (p < 0.001).
The presence of converted arteries, dilated veins, and intravenous trophoblastic fragments in decidual specimens were evidence of intervillous circulation and placental perfusion by maternal circulation in the first trimester. Also the insufficient conversion of the arteries in spontaneous abortions might be responsible for many cases of early pregnancy loss.
为了确定在早期流产病例中是否发生了足够的滋养层细胞迁移和母体胎盘灌注，我们比较了人工流产蜕膜与自然流产蜕膜中的血管。
将5 - 11周的人工流产蜕膜（n = 40）与5 - 12周的自然流产蜕膜（n = 25）进行比较。同时检查了正常晚期分泌期子宫内膜活检标本（n = 10）。在25份人工流产和15份自然流产材料中对静脉和动脉的横截面进行计数。确定含有滋养层细胞碎片的静脉数量以及被滋养层细胞转化的螺旋动脉数量。采用曼 - 惠特尼U检验和斯皮尔曼相关性检验，统计学显著性为p < 0.05。
所有蜕膜组均有扩张的静脉，但分泌期子宫内膜组没有。人工流产蜕膜中转化的螺旋动脉与未转化动脉的比例（113/938，12.04%）远高于自然流产蜕膜（11/511，2.15%）（p < 0.001）。
蜕膜标本中存在转化的动脉、扩张的静脉和静脉内滋养层细胞碎片，是孕早期绒毛间隙循环和母体循环胎盘灌注的证据。自然流产中动脉转化不足可能是许多早期流产病例的原因。
