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.

• 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]

  Placental infarction, unspecified trimester ICD-10-CM Siblings (same level / similar specificity) of O43.81: O43.89 - Other placental disorders [emedcodes.com]

  disorders, first trimester O43892Other placental disorders, second trimester O43893Other placental disorders, third trimester O43899Other placental disorders, unspecified trimester O4390Unspecified placental disorder, unspecified trimester O4391Unspecified [cms.gov]

  /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]

• 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]

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]

• Fibrinoid Necrosis

  In the spiral arteries of the basal plate of the placenta, lesions of intimal thickening, fibrinoid necrosis, acute atherosis, and intraluminal thrombosis were observed. [ncbi.nlm.nih.gov]

  Fibrinoid necrosis. Vessel wall lipid deposition. [librepathology.org]

  Increased numbers of villi with fibrinoid necrosis were also noted. Teasdale [ 18 ] did quantitative analysis of placentas in IUGR. [oapublishinglondon.com]

• Ischemic Changes

  OBJECTIVE: To correlate placental histopathology, in particular ischemic changes, with the clinical severity of preeclampsia. DESIGN: A blinded retrospective study. SETTING: One Swedish hospital. [ncbi.nlm.nih.gov]

guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine This video is limited to doctors and other health professionals. [medtube.net]

Treatment and prognosis Those that occur at the placental margins are usually of no clinical significance at this location. [radiopaedia.org]

Treatment Maternal bed rest is the initial approach for the treatment of IUGR. The benefit of bed rest is that it results in increased blood flow to the uterus. [healthofchildren.com]

Treatment The first line of treatment for placental abruption involves replacing the mother's lost blood with blood transfusions and fluids given through a needle in a vein. [medical-dictionary.thefreedictionary.com]

Treatment and prognosis Those that occur at the placental margins are usually of no clinical significance at this location. [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]

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]

[…] 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]

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]

Nonspecific villitis: Villitis of uncertain etiology (VUE) ; patchy villitis. [palpath.com]

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]

Fretts R: Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clinical obstetrics and gynecology 2010, 53(3):588-596. 3. [revistafertilidad.org]

Beebe LA, Cowan LD, Altshuler G (1996) The epidemiology of placental features: Associations with gestational age and neonatal outcome. Obstet Gynecol 87: 771–778. View Article Google Scholar 23. [journals.plos.org]

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]

There is still need to clarify pathophysiological mechanisms. [journals.plos.org]

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]

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]

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]

"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]

Fretts R: Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clinical obstetrics and gynecology 2010, 53(3):588-596. 3. [revistafertilidad.org]

My work with Healthy Birth Day External, a nonprofit organization dedicated to the prevention of stillbirth, helped me heal. Grace eventually blessed us with three healthy children. I know that she handpicked them just for us. Grace changed me. [cdc.gov]

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.