The review joins a publication in the fourth. docade of the 19th century and close wlth a publica-. Â claslflcatlon of abortes species is proposed. based on the pathological changes, supplemented by. abortion is specified in the following under each group.
Ml.ssed abortlon: The term tmissod abortlont
2,4, Specimens of nuLtlple pregnancy: There wore
- Tables; The tables refetred to in thls text are sub¡¡itted in a separate book, with the iLlustratiotrs,
- Befone L900
- Cyllndrical foetus
- Definltely crininal abortions
- Absonce of foetus
In intact chorionic sac
Stunted foetus: The foetus in theso cases
On microscopic examination¿- . tlon there is evidence of differentiation into organs such as . as the fetal brain and liver". The presence of differentiation is an important criterion in differentiating a stunted fetus from a nodular fetus. The cause of retarded dimensional growth is unknown. In some of these cases, the placenta, placenta and endometrium may also show pathological changes.
The . The anomalies in the present group include those known to occur in full term pregnancy, such as anencephaly, spina bifida, menlngocele, myelocelet polydacty, exomphal.os, cleft palate and other similar conditions. Malformations such as polydact) and cleft. Major abnormalities such as anencephaly, myelocele, encepilocele, and spina bifida are believed to lead to somo. However, changes in post-generation do not in themselves indicate any abnormality of the fetus, but only the fact that the fetus has been dead in the womb for some time. some.
The umbilical cord develops as an extension of the vitelline vessels of the fetus, hence absence of the. The specimens are therefore grouped with reference to the changes in fetus which are believed to be of utmost importance.
Torsion of cord
Stricture of cord
A fetus is seldom found in these specimens, possibly because it is rude, if present, and thus. The heenorrhege can be between the decldua and the pl,acentar or no bc just in the placenta in the inter-vllLous space. Inflammatory changes in the kidneys occur as a result of an infection; they are not incldentally to.
It is possible that in some of these cases the changes in the blood vessels are direct. Degenerative changes: Degenerative changes in the nebrane are frequently seen in species of abortion that are retained for several days after fetal death. Although these changes are pathological, they are a necessary part of the process of separation of the.
Inflannation: The degree of infiltration of the
- Inducod without uredical indications( 8) 2.4. Induced due to accident or trauma ( 6)
- Defective ova and trophoblast (159) 5,2. PLacentaL pathology ( 57)
The 22 growing fetuses were normal; among .., placental insufficiency was diagnosed in 10 and .. placental hemorrhage was the cause of abortion in 12. The effect of cord blood flow obstruction can be . it is only evaluated if the fetus is present. In these specimens .. the fetus is alnost, always macerated or degenerate, . because abortion occurs only a few days after the death of the fetus. There was torsion of the cord 1 in two, wrapping around the fetal parts in six and narrowing of the kidneys. two.
Chorionic vascular disease¡ All speclnens where . there is evidence of pathological changes in the chorionic blood vessels without any significant pathological changes. in the fetus cord or placenta is diagnosed.from .. this subgroup in the current series. In the present series, there was sufficient clinical evidence of zone. utero-placental abnormality was present without any. significant changes in the fetus, cord, placenta or. The cord was present in only one specimen. where it showed narginal insertion into the placenta; this. west a case of pl.acenta praevia. in all four species.
Placentas were received in L39 samples. in 35 and conslsted of degenerate vllli in the gennaining 10ó specimens. A nonmal placenta appeared. the presence of a small thrombus in one of its villi. In the remaining samples, no pathological cause could be suggested; of these are clinical information.
Ectopic pregnancies: There ale only 18 specimetrs
At the completion of the two year perlod of the .. present study, in March L967, the clinical notes of the .. abortion cases were searched for the diagnosis of ectopic pregnancies and induced abortions. The samples that were insufficient for diagnoses, and those that were demonstrated. inflammatory changes indicate true infection that you are then. grouped separately.y. Changes of defective ova and trophoblasts were considered the most important, . and samples in this group are divided into the different categories, as already specified in the previous chapter.
The conclusion is that all cases of abortion induced for medical indications are not necessarily normal. One of the specimens in which the other performed self-induction without medical indications showed a normal appearance of the fetus and placenta. The inference is that the normality of an abortion specimen is not inconsistent with its induction, without any medical necessity.
There are six cases with pathologic changes consistent with miscarriage due to prior tra¡¡ra or accident, placental hemorrhage infarction, and terminal infarction. Thirty-three percent, which is roughly the number, of spotimon in previous series were insufficient.
Septlc abortlons¡ The inflan¡retory changos scen
For example, it would be of value to determine the incidence of pelvic inflammatory disease, subsequent abortion, ectopic pregnancies and other gynecological diseases in women who have had septic abortions. lsolation of the organism causing infection in a serlcg of. cases will be useful in introducing preventive measures against its spread. It is considered that the cc changes occur at the perl conseplon. or peri-implantatlon stage of the fertilized egg. festival of the fertilized onrm in those species fs definitely. during its early days of growth, but the abortion occurs. At present it is impossible to say which of the changes is most in the fetus or placonta.
The causes of defective oocytes and trophoblast are. defective differentlatlon end abnormal growth. However, there is a possible explanation. that chromosomal abnormalities are an exprêsslon. deficient differentiation or abnormal growth in either. The finding of umbilical cord abnormalities in five of 20 stunted fetuses in this series supports the view. that vascular insufficiency is an important factor in
Cord structure and presence of a vossol blood alone in the cord will clearly result in a decrease in fetal blood supply, Exonpehlos does not. also produce th6 seme effect. Such cottages are not uncommonly seen in the placenta; they represent fibrosis of the villous strona following. Placental insufficiency can appear at the beginning of pregnancy. villous fibrosis with normal appearance oÈherwlse, or in the form of thickening of the basal membrane of cytotropho-. ft is important to distinguish fibrosis e. v1111 in placental insufficiency from fibrous changes in degenerative vi1li as a result of fetal death. fibrous villa of placental insufficiency dernonstrate poor. vascularity and are probably analogous to ravascul.ar. chorlonÍc villit i¡r term placenta described by Gruenwald.
Cord pethology
In the current series there is only one species in this group, that from a fetus with anencephaly. It is pertinent to note here that blood vessel changes in the third triester or term have pl.acentas. Although the results of experimental experiments cannot be clearly applied to human conditions, it is important to realize that vascular changes may be responsible for some of the abnormalities found.
Unilateral thickening of the fetal arteries in the placenta was not observed in Eerlos prosent. The latter authors found a marked decrease in serum chorionic-gonadotropin and urinary nedlan values. These observations suggest that the two functions of the ovary, ovulation and hormone productf.on,.
Lash and Lash (1950) and hydroclinamics proved the inability of the cervix as a cause of abortion. The true incidence could be higher, as one of the conditions would be pl.acenta praevia. The incidence of inadequate results was quite high, only 23 percent, which is almost a quarter of the dropouts.
The Clinical Aspects
Such specimens do not necessarily indicate an abnormality of the egg or trophobe. the criteria used in tire current stutter. represent the so-called torn ova, excluding malformed ones. The provisions of the present series do not agree with those of. 1957), and emphasizes the necessity of a careful evaluation of the pathological changes. The cause of abortion was discovered in 52.1 percent of the 7L4 specimens 1n the present series where.
For 72 percent it was based on pathological findings. effectively, a pathological sauce was found in only 37.3 percent. of the total number of abortions in utero, including tpltantomr. This once again brought attention to the importance of clinical treatment. pethological approach to this problem.and. Inadoquete spcclnens end ldlopathlc abortLon¡ accounted. for more than 40 percent of uterine abortion cases. A pathological cause was found in 37 percent of all cases. the clinical suspicion was that the uterus aborted, but reached SZ percent when the uterus regenerated. available for study, indicating the differences in determining the exact cause of abortion in a. large number of cases.
Cultural factors governing the validity of. hr¡nan placenta, based on the study of norphology. human placenta circulating lectures, with a review of the literature. studies on spontaneous abortions. I have carried out investigations on the mucous membrane of the horse. 0 observations on the incomplete cystic change ' of the stromal cells of the endomstrium. Some logical aspects of spontaneity. abortion: a review of recent literature. required to prove a prima facie case of trar¡matlc abortion or rnlscarrige. of the early human egg, with specular reference to the trophoblast of the earlier stage: A. description of 7 nornal and 5 pathological human eggs. threatened and permanent abortion: thelr patho-.
B. (1952): Congenital
A study of the blood circulation of the placenta. of 234 placentas with special reference to the. Btiological approach to common abortion. fertile in a Japanese population, with spcciate, reference to intrauterine selection due to. 1955) The significance of developmental anomalies of oocytes in the eology of abortions. erosome abnormalities associated with repeated abortions. Hunan abortions of known chronosonal constitution. group incompatibility in ebortion and sterility. 1875): In endometrlts docidualls chronica, ss a ceusc of abortion in a case of dlspLace-. of the pregnant utoruc.
Using exchange transfuslon for thc trcatment. gevero erythrobl.estosl.o due to A-B ecnsltizetLon, with observations on pathogens.
