Betty J. Poland

Reproductive counseling in patients who have had a spontaneous abortion

A detailed morphologic study was made of spontaneously aborted embryos and fetuses from 472 patients. These patients were followed through 638 subsequent pregnancies. The patients were divided into four groups, depending on their previous obstetric history. The outcome of the subsequent pregnancies was correlated with the previous obstetric history of the patient and the developmental status of the aborted specimen. Patients who had never had a live child in the previous obstetric history were identified as a high-risk group. Patients who had had live births and pregnancy loss previously were found to be at significant risk of a subsequent premature infant following the late abortion of a fetus.

EMBRYONIC DEVELOPMENT IN ECTOPIC HUMAN PREGNANCY

Ectopic pregnancy in the fallopian tube occurs in about 1 in 50 human pregnancies. Maternal factors in the etiology of this condition have been well documented. There is less information available on the development of the embryo or fetus. To document this information morphological and cytogenetic data were obtained from pregnancies occurring in the fallopian tube. Analysis of the data showed that tubal implantation was associated with a high proportion of severely disorganized embryos. There was also a high incidence of maternal tubal disease. The importance of these factors and the etiology of ectopic pregnancy is discussed.

The use of spontaneous abortuses and stillbirths in genetic counseling

From 1966 to the present, a special study of 902 abortuses and 204 stillbirths has been undertaken to try and identify morphologic and chromosome abnormalities. Information from such a study frequently can be applied to the clinical practice of medicine, i.e., genetic counseling.

The influence of recent use of an oral contraceptive on early intrauterine development

Abstract This paper presents the results of a study of 106 normal and abnormal fetuses aborted spontaneously by women who had recently been using an oral method of contraception. The incidence of abnormal development and the types of abnormality are presented and a comparison is made with 258 patients who suffered abortions but had used no oral or chemical method of contraception.

Embryonic development in consecutive specimens from recurrent spontaneous abortions

Although habitual abortion occurs in a relatively small number of patients, its successful management is often difficult. Etiologic factors may be either maternal or embryonic or both; there is much information available on maternal factors but little is known of factors related to the embryo. Information obtained from examining and karyotyping the aborted embryo or fetus may be of considerable importance in determining the possible cause of the abortion and subsequent investigation and counseling of the patient. At least two specimens from over 50 women who have had two or more consecutive spontaneous abortions have been examined and the results show that: (1) Patients aborted conceptuses of the same developmental stage, i.e., embryo or fetus, in consecutive pregnancies. This suggests that investigation should be directed to factors which may be important in the stage of pregnancy indicated. (2) Late abortions were associated with normal fetal development and factors related to the uterine environment. (3) The conceptus in an early abortion was significantly more likely to have a cytogenetic abnormality, suggesting a problem at, or prior to, conception/fertilization. A case study is also included.

Recurrent spontaneous abortion

A spontaneous abortion for most couples is considered to be a sporadic event with an empiric risk of between 15 and 20%. In a small proportion of cases (in the region of 5% of women of reproductive age), it appears as a recurring problem resulting in considerable distress to the couple concerned. After a first abortion, the risk of a second does not increase significantly, but for a third the empiric risk is doubled and may reach 50% after three consecutive spontaneous abortions, if there is no live child in the reproductive history (Poland et al., 1977). The increasing risk of recurrent abortion is indicative of a continuing problem, and additional evidence is provided by a study of the conceptuses from consecutive abortions which were of the same developmental category, that is, embryo or fetus, in 77% of cases (Poland and Yuen, 1978). In this study, 94% of 64 embryos were abnormal, and only 1 out of 24 fetuses. The outcome of a subsequent pregnacy also appears to be related to the time at which a previous abortion occurred. If the patient has a history of recurrent mid-trimester abortions, she is likely to have an increased risk of a subsequent premature birth (Gardiner and Yerushalmy, 1939). However, if she has a history of first-trimester or embryonic abortions, she does not have an increased risk of having either a premature delivery, or a child with an anomaly if a subsequent pregnancy is carried to term (Poland et al., 1977). Therefore, it seems that women who abort early almost always abort an abnormal embryo but have a better prognosis if a subsequent pregnancy is carried to term. Women who abort a normal fetus have an increased risk of a subsequent premature infant. In the etiology of recurrent abortion, considerable emphasis has been placed on maternal causes related to the endocrine system, uterine anomalies and pathology, and genetic factors. Undoubtedly, while recurrent abortion may present as a problem which can be successfully treated, identification of the causal factor may involve tedious and extensive investigations. However, if recurrent abortions can be identified as early or late depending on the stage that is, embryonic or fetal of