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Placental Infarction

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.


Presentation

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 [1] [2]. As a result, infarction seems to appear most frequently among hypertensive women and those suffering from vascular disorders (mainly preeclampsia and eclampsia) [1] [3]. The size of the infarct (as well as its location) may determine whether the fetus will be affected [3], 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 [1]. In most severe cases, fetal death can occur [1]. 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 [1] which are the typical signs of preeclampsia. Reduced abdominal size or fetal activity was reported by some women as well.

Hypoxemia
  • Dubiel M, Gudmundsson S, Gunnarsson G, Marsal K: Middle cerebral artery velocimetry as a predictor of hypoxemia in fetuses with increased resistance to blood flow in the umbilical artery. Early Hum Dev 1997;47:177-184.[karger.com]
Heart Block
  • The first was complete fetal heart block, demonstrated ultrasonographically, which correlated with the presence of anti-Ro and anti-La antibodies in the maternal serum.[ncbi.nlm.nih.gov]
Placental Disorder
  • […] trimester O43.892 Other placental disorders, second trimester O43.893 Other placental disorders, third trimester O43.899 Other placental disorders, unspecified trimester O43.9 Unspecified placental disorder O43.90 Unspecified placental disorder, unspecified[healthprovidersdata.com]
  • disorders O43.81 Placental infarction O43.811 …… first trimester O43.819 …… unspecified trimester O43.89 Other placental disorders O43.899 …… unspecified trimester O43.9 Unspecified placental disorder O43.90 …… unspecified trimester Reimbursement claims[icd10data.com]
  • , unspecified trimester ICD-10-CM Siblings (same level / similar specificity) of O43.81: O43.89 - Other placental disorders[emedcodes.com]
  • disorder, first trimester Or: 2015/16 ICD-10-CM O43.92 Unspecified placental disorder, second trimester Or: 2015/16 ICD-10-CM O43.93 Unspecified placental disorder, third trimester[icd9data.com]
  • Maternal floor infarction (MFI) and massive perivillous fibrin deposition (MPVFD) are pathologically overlapping placental disorders with characteristic gross and shared light microscopic features of excessive perivillous deposition of fibrinoid material[scholars.northwestern.edu]
Third Trimester Bleeding
  • Indications for pathologic examination include a poor pregnancy outcome (prematurity, intrauterine growth retardation, perinatal death and asphyxia), systemic maternal disorders, third-trimester bleeding and evidence of fetal or maternal infection. 2[aafp.org]
Behavior Disorder
  • .- ) Type 2 Excludes mental and behavioral disorders associated with the puerperium ( F53.- ) obstetrical tetanus ( A34 ) postpartum necrosis of pituitary gland ( E23.0 ) puerperal osteomalacia ( M83.0 ) Use Additional code from category Z3A, Weeks of[icd10data.com]

Workup

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 [1]. 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 [1]. 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 [1]. 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 [4]. 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 [1] [2].

Albuminuria
  • Its frequency was directly correlated with the gravidas' blood pressures, an effect augmented by albuminuria and work during pregnancy.[ncbi.nlm.nih.gov]

Treatment

  • Treatment and prognosis Those that occur at the placental margins are usually of no clinical significance at this location.[radiopaedia.org]
  • The effects of placental cerebral infarction could potentially last a lifetime, resulting in extensive medical treatments and diminished quality of life.[ohio-birthinjurylawyers.com]
  • Treatment for a placental hematoma infarction does not exist although the idea of using low molecular heparin and low dose aspirin to treat this condition is being investigated.[keepsakescissors.com]
  • Feist H, Blöcker T, Hussein K Optimal treatment of hypothyroidism associated with live birth in cases of previous recurrent placental abruption and stillbirth.[medicbind.com]
  • However, the authors did not offer treatment when fetal growth restriction was diagnosed.[karger.com]

Prognosis

  • Treatment and prognosis Those that occur at the placental margins are usually of no clinical significance at this location.[radiopaedia.org]
  • The overall prognosis is somewhat dependent on the presence or development of hydrops fetalis . In general, lesions larger than 4 cm are considered to produce haemodynamic effects on the fetus 3 .[radiopaedia.org]
  • Prognosis The prognosis for cases of placental abruption varies, depending on the severity of the abruption. The risk of death for the mother ranges up to 5%, usually due to severe blood loss, heart failure , and kidney failure.[medical-dictionary.thefreedictionary.com]
  • Prognosis Medical assistance of newborn in delivery room Medical assistance of newborn in neo-natology department Neonatal ressuscitation 10 th Theme : Outlet Forceps.[umfcv.ro]
  • With prompt treatment by experienced physicians specializing in these tumors, the prognosis and cure rates for patients are excellent. ABNORMALITIES OF THE UMBILICAL CORD Abnormalities in cord length. Umbilical cord length varies considerably.[drberman.org]

Etiology

  • The pathology was similar, but more pronounced in severe compared to mild preeclampsia, suggesting mild and severe preeclampsia to have similar underlying etiology. 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica 2010 Nordic Federation[ncbi.nlm.nih.gov]
  • Investigations for maternal and fetal etiologies, including toxemia, incompatibility of blood groups and types, and infections, proved negative.[jstage.jst.go.jp]
  • Kim SM, Cho BK, Kang MJ, Norwitz ER, Lee SM, Lee J, Park CW, Kim BJ, Jun JK, Park JS, Yi EC [Massive perivillous fibrin deposition, chronic histiocytic intervillositis and villitis of unknown etiology: Lesions of the placenta at the fetomaternal interface[medicbind.com]
  • […] income (neonatal asphyxia, low birth weight and intrauterine fetal death) Central infarcts, large ( 3 cm) infarcts and multiple infarcts indicate significant reductions in uteroplacental blood flow Minor areas of infarction are seen in 25% of placentas Etiology[pathologyoutlines.com]
  • Nonspecific villitis: Villitis of uncertain etiology (VUE) ; patchy villitis.[palpath.com]

Epidemiology

  • Keywords epidemiology fibrin infarction pathology placenta thrombi This is a preview of subscription content, log in to check access.[link.springer.com]
  • "The epidemiology of placental infarction at term.". Placenta 23 (4): 343-51. doi : 10.1053/plac.2001.0777. PMID 11969346. 4.0 4.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.).[librepathology.org]
  • Other epidemiological studies have shown associations between cardiovascular disease and placental syndromes, including preeclampsia, a condition characterized by high blood pressure in pregnancy; placental infarction, an interruption in blood flow between[sciencedaily.com]
Sex distribution
Age distribution

Pathophysiology

  • These findings represent the first experimental evidence to support Wigglesworth's theory and suggest that reduction in fetal blood flow prior to thrombosis of maternal vessels contributes to the pathophysiology of placental infarction.[ncbi.nlm.nih.gov]
  • The proposed pathophysiology of placental infarction hematoma is occlusion of a spiral artery leading to a placental infarction and subsequent recanalization of the vessel. This may result in the hematoma within the placental mass [ 1 ].[karger.com]
  • Term infants exposed to maternal hypertension had the same incidence of thrombocytopenia as the control population. 5 This finding suggests that hypertension effects may be of a different pathophysiologic pathway in term versus preterm infants.[nature.com]

Prevention

  • Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. ‏ الصفحة 332 - Crane JP, LeFevre ML, Winborn RC, et al.[books.google.com]
  • I feel there were many things done during my pregnancy....or I should say...not done or ignored that could have prevented our stillbirth.[justmommies.com]
  • Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention[aboutkidshealth.ca]
  • "Early lifestyle modifications, treatment with appropriate medications and routine follow-up may improve the cardiovascular profile of these patients and help prevent or reduce future poor pregnancy outcomes."[sciencedaily.com]
  • Prevention Some of the causes of placental abruption are preventable. These include cigarette smoking, alcohol abuse , and cocaine use. Other causes of abruption may not be avoidable, like diabetes or high blood pressure.[medical-dictionary.thefreedictionary.com]

References

Article

  1. Aurioles-Garibay A, Hernandez-Andrade E, Romero R, et al. Prenatal diagnosis of a placental infarction hematoma associated with fetal growth restriction, preeclampsia and fetal death: clinicopathological correlation. Fetal diagnosis and therapy. 2014;36(2):154-161.
  2. Kondo T. Placental infarction probably associated with late term premature delivery. J Surg Case Rep. 2014;2014(1): rjt125.
  3. Salgado SS, Pathmeswaran A. Effects of placental infarctions on the fetal outcome in pregnancies complicated by hypertension. J Coll Physicians Surg Pak. 2008;18(4):213-216.
  4. Ranganath L, Taylor W, John L, Alfirevic Z. Biochemical diagnosis of placental infarction/damage: acutely rising alkaline phosphatase. Ann Clin Biochem. 2008;45(3):335-338.

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Last updated: 2019-06-28 11:05