The Effects of Sample Quality in the Long-Term Culture and Chromosome Abnormalities Found in Early Pregnancy Loss

Background: Blighted ovum and fetal death are conditions when the zygote fails to develop during the first trimester and are classified as early pregnancy loss (EPL). Fetal chromosomal abnormalities cause more than 50% of EPL; therefore, every EPL case should undergo chromosomal analysis. Conventional cytogenetic analysis, as the gold standard, can only be done by culturing living cells undergoing mitosis. A chromosomal diagnosis cannot be established if the tissue condition is not good. Objective: This study aimed to identify the effects of sample quality associated with the successful long-term future growth of the tissue and chromosome abnormalities in early pregnancy loss specimens. Method: The design of this study design was cross-sectional. The long-term culture cytogenetic technique was done by applying collagenase enzyme as pre-treatment in fibroblast culture from curettage tissue. Chromosomal analysis was done using Wright staining with G-banding and analyzed using the Applied Imaging Computerized Cytogenetic system according to the International System for Human Cytogenetic Nomenclature 2016. Result: A total of 32 tissue specimens were enrolled in this study. The success rate of fetal fibroblast culture in this study was 56.3% (18 samples). Sample quality did not have a significant association with culture growth. Still, the presence of necrotic tissue (p<0.001), blood clots (p=0.005) and mucous (p=0.016) was significantly associated with bad quality of the chromosomes. Based on chromosome analysis done in successfully grown samples, we obtained seven samples (38.8%) with chromosomal abnormalities, such as aneuploidies and mosaicism. Conclusion: This study concluded that the successful growth of tissue culture is not affected by the sample quality. However, the quality of chromosomes valid for diagnosis is influenced by the sample quality, i.e. the presence of necrotic tissue, blood clot, and mucous.