Prenatal diagnosis of a placental infarction hematoma associated with fetal growth restriction, preeclampsia and fetal death: clinicopathological correlation

Abstract

The lesion termed 'placental infarction hematoma' is associated with fetal death and adverse perinatal outcome. Such a lesion has been associated with a high risk of fetal death and abruption placentae. The fetal and placental hemodynamic changes associated with placental infarction hematoma have not been reported. This paper describes a case of early and severe growth restriction with preeclampsia, and progressive deterioration of the fetal and placental Doppler parameters in the presence of a placental infarction hematoma.

Figure 1

Doppler parameters at the time of hospital admission (20 weeks and 5 days) when fetal growth restriction and preeclampsia were diagnosed.

Figure 2

Doppler parameters before fetal demise (21 weeks and 3 days).

Figure 3

Changes in the pulsatility index of the umbilical artery (UA), middle cerebral artery (MCA), uterine arteries (Ut Art) and ductus venosus (DV) during hospitalization.

Figure 4

Progressive changes in the echogenicity of the placental lesion in relation to gestational age (a-c). The area inside the cyst became more echogenic as gestation progressed (arrows). Additional small cystic areas are shown in Figure 4d.

Figure 5

Pathological examination of the placenta: a) the maternal surface shows an ill-defined yellow area (arrows) which coincided with the infarction hematoma; b) cut sections of the placenta show a large round hemorrhagic lesion surrounded by yellow infarcted placental tissues. Two additional small infarcts (arrows) are also present; c) basal decidual vessels with thick muscularized walls (arrows) and absent physiologic remodeling (persistent muscularization), d) fibrinoid deposition (arrow) in the arterial walls (atherosis), and e) decreased number of distal villi with increased syncytial knots and prominent stem villi.