The Clinical Aspects

From the

clinical

standpoint, the spontaneous

abortions mey be <livicled

irrto

two broad divisions:

(1) r^rhere pathol-ogicaL changes indicate

the futility

of any therapeutic measures; and

(2)

where investlgations,

early

antonataL care and therapy may increase the ^chances

of

pregrlancy progressing

to

term

in

a proportion

of

^cases.

The following specimens may be included

ln

the

first division:

defective ova and trophoblast (159),

stricture of

the cord

(2), foetal

^pathology

⁽¹⁾

^and

chorionic vascular dlsease (23), making

a

total"

of

¹⁸⁵

ebortions, an incidence

of

44.4 per cent

of the

^4L7

spontaneous abortlons

ln

the present

series.

Hertig

and Llvingstone (1944) analysed 1000 spocimons

of

abortion

into

two categories, ^nameLy due

to

ovular factors ^arid naternal

factors,

and found

that

6L.7 per cent ^boLonged

to

the former category where no therapy could have saLvagecl

the

abortions.

^They inclucled ^specimens

of vilLi

^on1y,

enpty chorionic sac regardless

of its

^being ruptured, placenta circumvallata and Breuss mole

in

the ^group of

ovular

fact,ors.

^{Such specimens} do not necossarlly lndicate an al¡normal.ity

of

the ^ovum

or

trophobLast accordlng to

the

criteria

used

in

tire present

stutty.

Colvin

ot

^a,1,

(1950) found

tirat

72,2 per cent

of their

440 abortions

represented the so-called blighted ova, excluding ^malforned

foetuses. Clinicallyn

^a blighted ^ovun

slgnlfles

^that

no treatnent couLd have saved the pregnancy and honce

thls

^group

is

anaLogous

to

tire

first division of

spontaneous

abortions suggested

above.

^{The high incidence of}

blighted ova

in

the series

of

Colvln

et aL.

(1950) is

accounted

for

by the iLL-deffned

criteria

^{they used from}

Mallf

s

⁽¹⁹¹⁷⁾ classif

ication.

Sirní1arLy, Iluber

et

aL.

(1957) discovered 68 abnornaL foetuses, includ.ing ^nine macerated ones, amongst 90

lntact or

cornplete specinens

out

of

a

total of

^3L4

abortions.

^They concl-uded that an abnormal foetus ^was present

in

^{more than one}

iralf

of patf-ents ^who

aborted.

This conclusion

is

iL1-founded because

1t

relates only

to ti¡e

90

lntact or

^complete

specinens, and does

not

take

into

consideration the

ronaining

abortions.

^The inclusio¡r

of

nacerated foetuses amongst the abnormaL

is

also

incorrect.

^The flndings of tho present series are

in

disagreement

with

those of

Hertig ^and Livingstone (1944), Colvln

et al.

⁽¹⁹⁵⁰⁾

and Huber e.t

al.

^{(1957), and} emphasl'ze the necesslty of a

careful

ovaluation

of

the pathological- changes.

The renaining about ^5ó per cent

of

spontaneous

abortions

ln

the present series belong

to

the ^second

division.

^{The foetus was norrnal}

in aLl

cases where

present and the placenta

did

not denonstrate any abnornality

145.

of

development.

rt is

tirerefore belioved

that

oarly antenatal care, and sonetinres pre-conceptional.

investigations and treatnrent, may increase the chances

of

a successful pregnancy

in

^sonre

of

these cases.

There were 677

uterine

abortions

in

the ^present series and

in

673 cases the maternal age was known

(Table

16).

The average age

of

the ¡nother vras 27.7 yeers

in

these 673

cases. rn

41s spontaneous abortfon casos

tlre maternal age ìías known aud the average age Ì{as

27.6

years.

Tire iucidence

of

the causes

of

sponteneous

abortion

in

^women under 27 years

of

age

is

compared with

that ín

women who were 27 years

of

age

or

over

at

the

tine of

abortion ^(TabLe

L7),

Althougtr there appears to bc

a

trencl towards e higirer incidence

of

defoctive ove and trophoblast, chorioriic vascular disease and atypical

endornetriun

in

wo¡ne¡r under zT yeats, _the differenco in the trvo age groups

is not statisti

caLLy

significant

at 5 per cent

Levol". Also,

tire difference

i¡r

the incidence

of

place¡rtal. pathology iretlveen tl¡e two age groups

is

not

significant at

5 per ceut

level. rt is

therefore concLuéed.

that

naternal age does

not

influence the ceuse of

spontaneous at¡ortion.

The cause

of

abortion was discovered

in

52.1 ^per cent

of the

7L4 specimens 1n the present series where

uterine abortlon was diagnosed

clinlcally

(Table xg).

Adequate specfunens were received

in

72.4 per cent of

ceses,

of

which over

two-thirds

(72 per cent) demonstrated

a cause, thus confirning

that

the ^chances

of finding

^a

ceuso

of

abortion are higher

if

the specinen

is

^adequate.

Anongst the specirnens where a pathological ^{c&use I{Bs} found,

it

was located

in the

foetus

in

29.8 per

cent,

in the cord

in

3.8 per

cent, in

the placenta

iu

59.6 per cent end

ln

the endonetriurn

in

6,8 per cent (Table 19).

The placenta

is

therefore the nost important organ

in

^an

abortion specinen

for

Locating a pathologfcal cause.

An Ínteresting coj.ncidence

in

Tables 18 and ¹⁹ nay be poiuted out

here. 0f

the totaL specirnens of uterine abortions, irreluding rphantonr, 72 per cent were adequate

for

diagnostlc ^purposes

of

whicir,

in

72 per cent, a cause

of

abortion ruas detected, and

of

these, in

72 per cent

it

^{was based} on pathological

firtdings.

In

effec,t,

a pathological sause was found ir:, only ³⁷

.3

per cent

of the

totaL uterine abortions including tpltantomr,

thus enpiiasLzing once agairr

the

importance

of

a

clinico-

pethological approach

to this

^probl.en.

L47,

ì

CHAPTER VII

CONCTUSIONS

The findings

of

the present study allow the

following conclusions :

(1)

A cl.assification

of

abortion specimens which is

basçd on abnormalitios

of

the foetus alone ig inconplete, sinco changes

in

other portions of the ^gestatlon products _can be responsible

for

abortion, and these abnonnal.ities aro found nore

froquently

in

the placenta than

in

the foetus.

(Z)

Since abortion

ís

a conplex process,

it is

^probably not

Justifíeble to classify

^{abortion specimens &s}

duo

to

ovular factors and maternal factors.

(5) In

view

of

the above, a new

classification is

^prcsented,

which takes

into

açcount pathological changes in every abortion specinen as a ^whole.

(4)

On tl¡c basls

of this classification,

defectlvo ^ova

and trophoblast constitutes the nost lnportent slngle

entity

sccounting

for

58.1 per cent

of

the spontancous abortion specinens

ín

the present study.

There were 159 specinens

of

dofectivo ova and tropho-

blast, of

whlch 88 were obtained

fron

women under 27 years

of

age end 7L

fron

^{rfromen aged} 27 years and over.,

(s)

(6)

(7)

(8)

(e)

(10)

(11)

(12)

(15)

(11)

Chorionlc vascular dicease and

etypical

ondometriun

are often associated

with

dofcctlve ova end.

trophoblest.

Vascular disturbances probably pley e

signiflcant role ln

the csusation

of

abortlon as n¡nLfested by

placental

infarctlon

^and haenorrhage, cord ^pathology and chorionic vascular dlsease.

Plecent,a1

ínsufficloncy,

which

ls

char¡cterized ^by

speclfic

chengos

in

the

viLlt,

can occur durlng

early prognancy end

rcsult fn

abortion,

Pathological. ^changes

in

the u¡nbil.ic,rl cord form ^a

distinct

sause

of

abortlon when thero

is

^evidonce

of

obstruction

of

cord circuLation.

A comnon

finding in

abort,ions due

to

eccldont end

trauma

ls

^placental

infErctlon

and heenorrhsge.

Approxlnetely 44 per cent

of alL thc

apontaneout

abortions

in this

scrlos hed

lrreverslblo

^changcs

which could not havé beon corrected by ^t,herapy.

Maternel age

did not

fnfluence the pat,hological sause

of

abortion.

The averagc naternal ege

in a1l

casc!¡

of

^utcrine

abortions was 27.7 years.

Inadoquete spcclnens end ldlopathlc abortLon¡ ^accounted

for

over 40 per cent

of

the uterlne abortlon spccinens.

A pathoLoglcal cause was found

ln

³⁷ per cent

of all

1.49.

the

clinlcally

^suspected

uterine

abortLons, but reached SZ per cent when edequato materlsl ^wes

avalleble

for

study, thus

lndicating

the

dtfflculties In

deterninlng the exect çause

of

abortlon

in

^a

large nr¡nber

of

çases.

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65: ^{1065 -L077 ,}