The role of embryopathology in the study of first trimester spontaneous miscarriage

Abstract

The study of first trimester spontaneous miscarriage is the object of increasing attention not only for clinicians but also for patients and their family. Embryopathology concerns the study of pathologic conditions and malformations like early development failure, development alterations and true malformative lesions. It is well known that the most severe genetic abnormalities emerge as an interruption in embryogenesis and that the most complex developmental abnormalities caused by external factors - like infections, toxic and environmental agents - have their onset in the early stages of embryo formation and are often also the cause of pregnancy loss. In order to improve the monitoring of at risk couples we have expanded the study of basic research with those of research applied to human pathology. The role of embryopathology is fundamental to understand the timing at which the embryo development failure and its subsequent death actually occur and the main defect in embryo formation underlying development abnormalities. From 1994 to 2010 we examined 256 early spontaneous abortions in which an intact gestational sac was present. The introduction of acrylic resin embedding technique in 1995 added many advantages such as the possibility of obtaining semi-thin and uniformly thick sections with better histological and cytostructural details, assuring the almost total absence of coartation, and the preservation of antigenic properties. This technique therefore permits improvement in morphological obervation in order to reinterpret the classification of spontaneous aborted embryo. This enables a better definition of the real stage and time when development was interrupted. That is the basis to understand the role of external factor as a cause of pregnancy loss.