Placental gross/microscopic abnormalities, non-neoplastic
Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 16 November 2011, last major update October 2011
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● Villous necrosis secondary to local obstruction of maternal uteroplacental circulation
● Due to extensive placental reserve, small infarcts and those at the margin are usually clinically insignificant
● Need >30% placental involvement to affect fetal 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
● Associated with maternal hypertension, preeclampsia, Rh incompatibility, connective tissue disorders, retroplacental hematomas (abruptio placenta, associated with cocaine) or maternal thrombophilia
● Pale, indurated focus with granular cut surface in placenta parenchyma
● Recent infarcts are red and may not be appreciated
● Grossly, the differential diagnosis includes hematomas (usually lobular), subchorionic fibrous plaques, perivillous fibrin deposition (usually venous lesions), intervillous laminated thrombi and intraplacental choriocarcinoma (looks grossly like an infarct)
● Collapsed villi with “ghost”-like appearance due to loss of nuclear basophilia / karyorrhexis
● Intervillous space is obliterated due to increased fibrin deposition and villous agglutination
● Marked congestion of villous vessels, lobular distribution
● No villous stromal fibrosis, no cytotrophoblastic proliferation
Pale necrotic chorionic villi
End of Placenta > Placental gross/microscopic abnormalities, non-neoplastic > Infarct
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