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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.

Papule
  • Intrahepatic cholestasis of pregnancy Integumentary system / dermatoses of pregnancy Gestational pemphigoid Impetigo herpetiformis Intrahepatic cholestasis of pregnancy Linea nigra Prurigo gestationis Pruritic folliculitis of pregnancy Pruritic urticarial papules[en.wikipedia.org]
Linea Nigra
  • nigra Prurigo gestationis Pruritic folliculitis of pregnancy Pruritic urticarial papules and plaques of pregnancy (PUPPP) Striae gravidarum Nervous system Chorea gravidarum Blood Gestational thrombocytopenia Pregnancy-induced hypercoagulability Maternal[en.wikipedia.org]
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]
  • O43.8 Other placental disorders O43.81 Placental infarction[coding-pro.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]
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]
Breast Engorgement
  • engorgement Diastasis symphysis pubis Peripartum cardiomyopathy Postpartum depression Postpartum thyroiditis Puerperal fever Puerperal mastitis Other Concomitant conditions Diabetes mellitus Systemic lupus erythematosus Thyroid disorders Maternal death[en.wikipedia.org]

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].

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]
  • Prognosis Outcomes for infants with IUGR differ depending on whether the condition is symmetrical or not and whether there are other sequelae from the underlying cause of the IUGR.[healthofchildren.com]

Etiology

  • The pathology was similar, but more pronounced in severe compared to mild preeclampsia, suggesting mild and severe preeclampsia to have similar underlying etiology.[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

  • Related Articles, Links The epidemiology of placental infarction at term. Becroft DM, Thompson JM, Mitchell EA. Department of Paediatrics, University of Auckland, Auckland, New Zealand.[homebirth.org.uk]
  • 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]
  • 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]
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]
  • There is still need to clarify pathophysiological mechanisms.[journals.plos.org]
  • 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]
  • The pathophysiology of PKU is centered on the deficiency of PAH enzyme or of the BH4 cofactor, resulting in hyperphenylalanina with toxic effect on the nervous system.[healthdocbox.com]

Prevention

  • Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. ‎ Seite 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]
  • A mechanism for preventive medicine in the newborn. ‎ Página 174 - A clinical test useful for predicting the development of acute hypertension in pregnancy", Am. ‎[books.google.es]
  • 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]

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: 2017-08-09 14:39