PubMed · 7347472
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U Thakkar, D S Wacha. Foetus papyraceus.. https://pubmed.ncbi.nlm.nih.gov/7347472/
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The placental lesions generally attributed to the effects of systemic lupus erythematosus (SLE) on the decidual and placental villi include decidual vasculopathy, placental infarcts and possibly intrauterine growth retardation. The maternal decidual vessels in SLE show a lesion termed "acute atherosis" which is histologically similar to acute vascular rejection in a transplanted kidney. These changes can be so extensive as to result in complete vascular occlusion, decreased placental perfusion and resultant placental villous infarction. In currettings from products of conception in the first trimester, acute atherosis is a rare finding. We describe striking decidual vasculopathy and extensive villous infarction in a case of a first trimester missed abortion in a patient with SLE who had anticardiolipin antibodies (ACL), both immunoglobulin (IgG) and IgM, and lupus anticoagulant (LA) in her serum. To the best of our knowledge, this is the first report of acute atherosis and villous infarction in a first trimester placenta in association with SLE and/or ACL and LA. Pathologists should be aware of these changes and alert clinicians to the possibility of SLE or antiphospholipid and/or anticardiolipin antibodies.
In an ultrasound screening study at 10-13 weeks of gestation involving 17,870 women, the prevalence of early pregnancy failure was 2.8% (501 cases), including 313 (62.5%) missed abortions and 188 (37.5%) anembryonic pregnancies. Lower gestation and higher maternal age were associated with a higher prevalence (chi 2 = 143.5; p < 0.001 and chi 2 = 53.3; p < 0.0001, respectively). The prevalence was higher in women with a history of vaginal bleeding (chi 2 = 141.5; p < 0.0001), but there was no significant association with previous pregnancy losses (chi 2 = 2.8), parity (chi 2 = 0.6) or cigarette smoking (chi 2 = 0.0). Recent evidence suggests that the most effective method of screening for chromosomal abnormalities is measurement of fetal nuchal translucency thickness at 10-13 weeks, and therefore ultrasound examination at this gestation is likely to become universally available. As shown in this study, an additional advantage of such a scan is the diagnosis of early pregnancy failure, which will be found in about 3% of patients examined. Elective evacuation of retained products of conception is likely to be more cost effective and potentially safer than emergency surgery in a patient presenting during miscarriage.