Maternal Floor Infarction/Massive Perivillous Fibrin Deposition Associated with Hypercoiling of a Single-Artery Umbilical Cord: A Case Report

Abstract

Maternal floor infarction is a rare and idiopathic placental disorder associated with adverse obstetric outcomes and a high rate of recurrence in subsequent pregnancies. The pathogenesis of maternal floor infarction is unclear but has been linked to diverse underlying maternal conditions, including gestational hypertension/preeclampsia, immune-mediated diseases, and thrombophilia. Few reports link maternal floor infarction to fetoplacental conditions. We report a 34-week, macerated, growth-restricted male fetus for which the placenta showed maternal floor infarction. The umbilical cord showed excessive coiling and a single umbilical artery. These cord changes are postulated to have resulted in increased placental villous resistance and decreased fetal blood flow, creating a hydrostatic pressure gradient between the villous stroma and the intervillous space. The pressure changes could then lead to trophoblast damage and fibrinoid deposition, contributing to the maternal floor infarction in this case.

Pathoanatomical Lesions in Placentas With Excessively Hypercoiled Umbilical Cords: Frequent Detection of Massive Perivillous Fibrin Deposition

“…The authors assumed that umbilical cord hypercoiling may create a raised hydrostatic pressure on villous vessels that may be high enough to rupture and damage trophoblastic cells resulting in MFD/MFI. 25 In early miscarriages with retention, we often see fibrin deposition. However, in stillbirths of the second and the third trimesters, macroscopic and histologic prominent fibrin deposition is not mentioned as a morphologic sign of a long retention period after IUFD.…”

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 .…”

Massive Perivillous Fibrin Deposition in Congenital Cytomegalovirus Infection: A Case Report

“…This has been illustrated in the literature in a case of MPVFD associated with hypercoiling and a single artery umbilical cord and in a report of 2 cases in which the fetuses suffered from oligohydramnios due to bilateral cystic renal dysplasia. 13 , 14 Hypotheses also include blood flow stasis, procoagulant effect, and trophoblastic pathology resulting in abnormal secretion of extracellular matrix proteins. 2 In our case, we postulate that the CMV infection caused cytotrophoblast injury, which resulted in the deposition of fibrinoid material as a response to the injury.…”