First-trimester Pregnancy Loss Research Articles

Arteriovenous malformation of the uterus associated with a missed abortion.

Arteriovenous malformation of the uterus is a rare uterine abnormality. This entity is generally associated with the presence of molar disease, choriocarcinoma and uterine surgery, but may be congenitally acquired. The presence of an arteriovenous malformation generally leads to unexplained profuse uterine bleeding. The diagnosis of this entity has traditionally been made by arteriography, and the treatment is usually hysterectomy. We present a patient with an arteriovenous malformation of the uterus whose prior delivery was by Cesarean section. The patient experienced episodes of heavy vaginal bleeding in the first month following the procedure of suction curettage for a first-trimester pregnancy loss. Chorionic villus sampling performed prior to the procedure showed a chromosomally normal fetus. The diagnosis of an arteriovenous malformation was made by color Doppler velocimetry and confirmed with arteriography. The patient desired to maintain her fertility. Interventional radiological techniques were successfully utilized to obliterate the arteriovenous malformation with the use of polyvinyl alcohol particles (250 micro m) and gelfoam. Discussion includes the presenting signs and symptoms along with the method of both diagnosis and conservative management.

Analyses of 95 first-trimester spontaneous abortions by chorionic villus sampling and karyotype.

Our purpose was to determine the incidence of chromosomal aneuploidy in first-trimester pregnancy losses using chorionic villus sampling (CVS). All patients presenting for CVS with no fetal cardiac activity were offered CVS. Cytogenetic results were completed in 95 of 96 cases (99%). Eighty-three percent of the karyotypes were aneuploid. The 16 euploid fetuses had no excess of females. CVS is the most reliable method of determining the karyotype of spontaneously aborted fetuses. The incidence of aneuploidy is much greater than in previous reports that analyzed passed products of conception. CVS should be offered to women who present with first-trimester spontaneous abortions.

Repeated first-trimester pregnancy loss: Evaluation and management

The clinical management of repetitive first-trimester pregnancy loss is handicapped by inadequate answers to four fundamental questions. These questions center around understanding the true scope of the problem, differentiating between euploidic and aneuploidic loss, identifying the parental source of the gametogenic error, and clarifying the role of molecular developmental mutants in euploidic abortion. In spite of these limitations a diagnostic and therapeutic program is outlined for couples with repetitive early abortion. Informational gaps are identified and the future role of molecular biology in clarifying some of these issues is optimistically outlined.