The impact of placental massive perivillous fibrin deposition on neonatal outcome in pregnancies complicated by fetal growth restriction

Arsenio Spinillo; Barbara Gardella; Giulia Muscettola; Stefania Cesari; Giacomo Fiandrino; Chryssoula Tzialla

doi:10.1016/j.placenta.2019.09.007

The impact of placental massive perivillous fibrin deposition on neonatal outcome in pregnancies complicated by fetal growth restriction

Placenta. 2019 Nov:87:46-52. doi: 10.1016/j.placenta.2019.09.007. Epub 2019 Sep 17.

Authors

Arsenio Spinillo¹, Barbara Gardella², Giulia Muscettola², Stefania Cesari³, Giacomo Fiandrino³, Chryssoula Tzialla⁴

Affiliations

¹ Department of Obstetrics and Gynecology, University of Pavia, Piazzale Golgi, 19 Pavia, Italy. Electronic address: spinillo@smatteo.pv.it.
² Department of Obstetrics and Gynecology, University of Pavia, Piazzale Golgi, 19 Pavia, Italy.
³ Department of Pathology, University of Pavia, Piazzale Golgi, 19 Pavia, Italy.
⁴ Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Piazzale Golgi, 19 Pavia, Italy.

PMID: 31546153
DOI: 10.1016/j.placenta.2019.09.007

Abstract

Introduction: Massive perivillous fibrin deposition (MPDD) is an uncommon placental lesion which has been associated with an increased risk of adverse pregnancy outcome in retrospective series. The purpose of the study was to evaluate the frequency and consequences of MPFD in pregnancies complicated by fetal growth restriction (FGR).

Materials and methods: A cohort study of 355 pregnancies complicated by FGR diagnosed according to standard ultrasonographic criteria, enrolled, followed and delivered at a single obstetric unit. Pathological placental lesions were classified according to the Amsterdam Placental Workshop Consensus. Penalized logistic regression models were used to evaluate the association of MPFD with maternal risk factors, other pathological lesions and neonatal outcome.

Results: The rates of moderate (25-50% of villi) and severe (>50% of villi) MPFD were 8.7% (31/355) and 3.1% (11/355), respectively. Compared to other FGR cases, MPFD pregnancies were characterized by higher placental volume (450 ± 144.5 SD as compared to 412.2 ± 151 cm³,p < 0.001) and lower birthweight/placental weight ratio (5.32 ± 1.53 compared to 6.1 ± 1.52,p < 0.001). The rates of abnormal Doppler ultrasound studies of umbilical and middle cerebral artery were similar in MPFD subjects and controls. After correction for gestational age and birthweight, MPFD was associated with an increased risk of neonatal intraventricular hemorrhage (>grade II) (OR = 5.66,95% CI = 1.69-18.97), sepsis (OR = 5.9, 95% CI = 1.27-27.12), proven necrotizing enterocolitis (OR = 9.84,95% CI = 2.49-38.8) and overall severe adverse neonatal outcome (OR = 5.71,95% CI = 2.05-15.87).

Conclusions: Moderate-to-severe MPFD was relatively common among FGR pregnancies and was associated with morphometric modifications of placenta and with an increased risk of severe adverse neonatal outcome.

Keywords: Fetal growth restriction; Fetal vascular malperfusion; Maternal vascular malperfusion; Neonatal adverse outcome; Perivillous fibrin deposition.

MeSH terms

Adult
Birth Weight
Chorionic Villi / metabolism
Chorionic Villi / pathology
Cohort Studies
Female
Fetal Growth Retardation / diagnosis
Fetal Growth Retardation / epidemiology
Fetal Growth Retardation / metabolism*
Fetal Growth Retardation / pathology
Fibrin / metabolism*
Gestational Age
Humans
Infant, Newborn
Infant, Small for Gestational Age
Male
Placenta / metabolism*
Placenta / pathology
Placenta Diseases / diagnosis
Placenta Diseases / epidemiology
Placenta Diseases / metabolism*
Placenta Diseases / pathology
Pregnancy
Pregnancy Outcome* / epidemiology
Prognosis
Retrospective Studies
Severity of Illness Index

Substances

Fibrin