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The hypothesis that late miscarriage is associated with reduced trophoblast invasion and spiral artery transformation was tested in a large series of placental bed biopsies containing decidua and myometrium from late, karyotyped, embryonic miscarriage (\u226513 weeks' gestation; <jats:italic>n<\/jats:italic> = 26; <jats:italic>n<\/jats:italic> = 96 spiral arteries) and gestationally matched ultrasound\u2010dated normal pregnancies (<jats:italic>n<\/jats:italic> = 74; <jats:italic>n<\/jats:italic> = 236 spiral arteries). Cryostat sections were immunostained using an avidin\u2013biotin peroxidase technique for cytokeratin, desmin, and von Willebrand factor to detect trophoblast, myometrium, and vascular smooth muscle and endothelium, respectively. Trophoblast invasion and individual features of spiral artery transformation were assessed and analysed using a logistic regression model. Compared with normal pregnancy, myometrial spiral arteries in late miscarriage showed reduced endovascular (4% vs. 31%, <jats:italic>p<\/jats:italic> = 0.001) and intramural trophoblast (76% vs. 88%, <jats:italic>p<\/jats:italic> = 0.05), and less extensive fibrinoid change (4% vs. 18%, <jats:italic>p<\/jats:italic> = 0.01). In contrast, endovascular trophoblast in decidual spiral arteries was increased (40% vs. 66%, <jats:italic>p<\/jats:italic> = 0.04). These findings suggest that, in common with pre\u2010eclampsia, late sporadic miscarriage may be associated with reduced trophoblast invasion and inadequate transformation of myometrial spiral arteries. Copyright \u00a9 2006 Pathological Society of Great Britain and Ireland. 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