Abnormal development of the vasculosyncytial membrane in early pregnancy failure.
OBJECTIVE
To investigate chorionic villous vasculogenesis (maturation) and development of the vasculosyncytial membrane (margination) using CD34 immunohistochemistry.


METHODS
Case-control study.


METHODS
Microscopic analysis of first trimester chorionic villi.


METHODS
Twelve patients with anembryonic pregnancies, 12 with embryonic death, and 12 with terminated normal pregnancies.


METHODS
Quantitative analysis of chorionic villi blinded to group and gestational age using CD34 immunohistochemistry.


METHODS
Vascular parameters (mean functional vascular area, vessels with a lumen, and hemangiogenetic cords, peripherally or centrally located).


RESULTS
Terminated normal pregnancies show significantly more vessels per chorionic villus (maturation) (mean +/- SEM) in comparison with embryonic deaths and anembryonic pregnancies (5.3 +/- 0.3 vs. 1.4 +/- 0.2 and 0.7 +/- 0.1), located mainly peripherally (margination) (3.0 +/- 0.2 vs. 0.9 +/- 0.2 and 0.2 +/- 0.0). Anembryonic pregnancies show significantly more centrally located cords in comparison with embryonic deaths and termination of pregnancies (3.3 +/- 0.2 vs. 2.7 +/- 0.2 and 1.5 +/- 0.1).


CONCLUSIONS
A defective chorionic villous vascularization, demonstrating inadequate vasculogenesis and abnormal development of the vasculosyncytial membrane, is seen in pregnancies complicated by embryonic death and is even more pronounced in anembryonic pregnancies. Initiation of placental vasculogenesis is a basic feature in all types of pregnancy and is subsequently modulated directly or indirectly by embryonic signaling.
Lisman
Babette A M
BA
Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Haarlem, Haarlem, The Netherlands.
Boer
Kees
K
Bleker
Otto P
OP
van Wely
Madelon
M
van Groningen
Krijn
K
Exalto
Niek
N
D000028:Abortion, Induced; D001808:Blood Vessels / Q000473:pathology*; D002824:Chorionic Villi / Q000473:pathology*; D005260:Female; D005313:Fetal Death; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D018919:Neovascularization, Physiologic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D011261:Pregnancy Trimester, First