Placental infarction is strongly associated with preeclampsia and other vascular abnormalities that cause impaired vascular supply to the placenta. Depending on the severity and the location of the infarct, reduced fetal growth, and metabolic abnormalities can cause significant harm to the fetus, or even death. Imaging studies, such as ultrasonography, and histopathological examination of the placenta, when possible, are used to make the diagnosis.
The clinical presentation of a placental infarction stems from various abnormalities of the placental vascular system. Thrombosis of the spiral arteries, increased fibrin deposition in the perivillous or intervillous areas causing strangulation of the placental villi, and thrombotic vasculopathy all lead to significant reductions in the placental blood supply  . As a result, infarction seems to appear most frequently among hypertensive women and those suffering from vascular disorders (mainly preeclampsia and eclampsia)  . The size of the infarct (as well as its location) may determine whether the fetus will be affected , and indeed, smaller infarcts are largely asymptomatic and cause no harm. However, larger disruptions in the vascular supply lead to placental insufficiency. A rapid deterioration of vital parameters are observed during regular examinations, and growth may be severely affected or even completely cease if the infarction causes major blood flow reduction . In most severe cases, fetal death can occur . Maternal symptoms are practically absent, which is why the diagnosis is often difficult to make in the initial stages of the condition, although case reports have reported women suffering from sudden headaches, hypertension, and proteinuria  which are the typical signs of preeclampsia. Reduced abdominal size or fetal activity was reported by some women as well.
If maternal hypertension is present, or if disruption of fetal growth is observed, immediate laboratory and imaging workup is necessary to exclude placental infarction as the underlying cause. Ultrasonography can reveal fetal weight well below the 25th percentile curve for gestational age (as low as below 5 percentiles have been noted), varying placental thickness and a heterogeneous appearance of the placenta itself . In addition, abnormal fetal heart rate, reduced amniotic fluid volume and multiple cystic areas in the placenta suggesting infarction, all poor prognostic factors, may be seen . Some studies have advocated the use of magnetic resonance imaging (MRI) in early stages of placental insufficiency because it might be able to detect pathological changes seen in this condition . Additionally, several biochemical parameters have been proposed as signs of infarction. Alkaline phosphatase (ALP), which is produced and secreted by the placenta into the maternal circulation, has shown significantly higher values in the setting of inadequate placental function, suggesting its potential role in the diagnostic workup, while marked decreases in human chorionic gonadotropin (hCG) was also proposed as an indicative sign of placental infarction . The diagnosis can be confirmed through a histopathological examination, wherein focal infarcts, areas of fibrin deposition and accompanying necrosis, as well as muscularization, may be noted  .