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Placenta

Placental gross/microscopic abnormalities, non-neoplastic

Fetal thrombotic vasculopathy (FTV)


Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 10 October 2011, last major update October 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Thrombosis of fetal vessels results in fibrosis of downstream villi
● Implies an increased risk for neurologic injury, growth restriction, oligohydramnios and renal / systemic thrombosis (Hum Pathol 1999;30:759)
● Clinical abnormalities associated with 30%+ avascular villi (Hum Pathol 1995;26:80)

Etiology
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● May be associated with maternal diabetes, hypercoagulable disorders (Hum Pathol 2000;31:1036), maternal diabetes or perinatal liver disease

Gross description
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● Large thrombi of chorionic vessels may be visible
● Areas of involvement may appear pale and firm

Micro description
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● Occlusive thrombi in large stem vessels are accompanied by downstream changes including organization, septation, red cell extravasation, endothelial destruction, loss of vascularity and ultimately fibrosis
● Trophoblastic basement membrane mineralization is common
● Grading is based on the number of affected villi: focal (3-5 avascular villi), intermediate (6-19 villi) or large (>20 villi)
● Massive or extensive involvement is defined as 25-50% affected parenchyma
● Changes are similar to those seen in intrauterine fetal demise but are focal rather than diffuse
● Associated pathologic findings may include meconium staining, villous chorangiosis and infarction

End of Placenta > Placental gross/microscopic abnormalities, non-neoplastic > Fetal thrombotic vasculopathy (FTV)


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