Abstract
The purpose of our study was to assess trophoblastic and uterine sufficiency in miscarriage pathogenesis with immunohistochemical methods and to determine if they could be used as a screening tool for the risk of miscarriage in the future. Placental tissue specimens that were comprised of 20 spontaneous abortions, 23 voluntarily terminated (induced) abortions, and 12 tubal pregnancies were included in this study. Trophoblastic cells and implantation area were evaluated for staining with EGFR-1, MMP-3, and MMP-9 by immunohistochemistry. EGFR-1 expression was more intense and diffuse in decidual cells in the placental bed of spontaneous abortion specimens; this difference was statistically significant (P=0.004). MMP-3 expression was markedly increased in villous and extravillous trophoblastic cells in induced abortions; the difference between the groups was found to be statistically significant (P values ranged from < 0.01 to 0.005). MMP-9 expression tended to be higher in spontaneous abortion and tubal pregnancy specimens, and the results were statistically significant as P values were lower than 0.01. Higher EGFR-1 expression in the decidual tissue of spontaneous abortion specimens suggests that EGFR-1 triggers the migration of extravillous trophoblasts, leading to their destructive invasion. Similarly, MMP-9 immunopositivity might be indicative of aggressive invasion contributing to spontaneous abortion pathogenesis. Relatively high levels of MMP-3 expression in induced abortion specimens used as a control group might be a predictor of successful implantation, whereas its decreased expression might be indicative of risk for pregnancy loss.
Highlights
Spontaneous abortion is defined as the rejection of an embryo or fetus weighing less than 500 g and conceptus material consisting of placenta and its supplements from the uterus before 20-22 weeks of pregnancy [1,2]
The majority of cytotrophoblastic, syncytiotrophoblastic and extravillous trophoblastic cells showed level 3 EGFR-1 immunostaining in all three clinical groups
Level 3 immunostaining was determined for matrix metalloproteinases (MMPs)-3 in syncytiotrophoblastic cells in most induced abortion cases when compared with spontaneous abortions and tubal pregnancy (p< 0.01) (Table II) (Figure 1)
Summary
Spontaneous abortion is defined as the rejection of an embryo or fetus weighing less than 500 g and conceptus material consisting of placenta and its supplements from the uterus before 20-22 weeks of pregnancy [1,2]. The incidence of abortion, the most common complication of pregnancy, is approximately 15% in clinically diagnosed pregnancies. Chromosomal abnormalities are present in 50% of all spontaneous abortion materials, the percentage is as high as 70% in miscarriage specimens in the 6th week of gestation [1]. Anatomical abnormalities, multiple gestations, antiphospholipid antibodies, and medications are among the other etiological factors of early pregnancy loss. The mechanism underlying abortion has not been precisely elucidated. An explanatory cause of recurrent pregnancy losses cannot be found in 60%-70% cases [1,3,4,5]
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