Maternal Floor Infarction Associated with Oligohydramnios and Cystic Renal Dysplasia: Report of 2 Cases

Abstract

Maternal floor infarction (MFI) is an unusual, idiopathic placental disorder characterized by deposition of amorphous fibrinoid material along the maternal aspect of the intervillous space. This condition is associated with poor perinatal outcome-in particular, spontaneous abortion-fetal growth restriction, and stillbirth, with a high recurrence rate in subsequent pregnancies. It is unknown whether MFI is a single entity or the common end point of different insults. Most studies have linked MFI to underlying maternal disorders including gestational hypertension, autoimmune disease, and thrombophilia. In contrast, there have been only a few case reports regarding the possibility of a fetal basis for MFI. We report 2 cases of MFI in fetuses who suffered from oligohydramnios as a result of bilateral cystic renal dysplasia. These 2 cases suggest the concept that fetoplacental factors may also play a role in MFI. It is speculated that the mechanism might involve changes in intrauterine hydrostatic pressure gradients.

Hypospadias, Intrauterine Growth Restriction, and Abnormalities of the Placenta

“…This association of IUGR, hypospadias, and abnormalities of the placenta is one of the small number of fetal abnormalities associated with placental abnormalities. Other examples are the twin–twin transfusion syndrome (Hoyme et al, ) and the association of fetal renal tubular dysgenesis and associated abnormalities of the placenta (Taweevisit and Thorner, ; Linn et al, ). The findings reported in the placenta of the latter condition have been described with the term “maternal floor infarction” in association with massive perivillous fibrin deposition.…”

Recurrent Massive Perivillous Fibrin Deposition in the Placenta Associated with Fetal Renal Tubular Dysgenesis: Case Report and Literature Review

“…Fetal conditions associated with MPVFD have been proposed before, including infection [46] and the aforementioned LCHAD mutation [18]. Oligohydramnios induced by RTD might lead to MPVFD secondary to changes in intrauterine hydrostatic pressure gradients, as suggested by Taweevisit and Thorner [21]. These authors suggest that oligohydramnios leads to a reduction in the fetoplacental circulatory fluid volume, which produces hypoxia, and in response to this hypoxia, the chorionic veins and downstream villous venules constrict.…”

Placental pathologic lesions with a significant recurrence risk – what not to miss!

“…MPFD/MFI is a rare lesion, reported in <1% of all pregnancies . Its clinical significance involves many fetal and neonatal morbidities including severe IUGR , preterm birth (PTB) , cystic renal dysplasia , hypercoiled umbilical cord with single umbilical artery , renal tubular dysplasia , fetal metabolic disease with reported mutations in the LCHAD (long‐chain 3‐hydroxyacyl‐CoA‐dehydrogenase) gene , and oligohydramnios . Neonatal morbidities include an association with neurocompromise .…”