Obstetric and Perinatal Complications in Placentas with Fetal Thrombotic Vasculopathy

Abstract

Fetal thrombotic vasculopathy (FTV) is a placental lesion characterized by regionally distributed avascular villi and is often accompanied by upstream thrombosis in placental fetal vessels. Previous studies, using preselected populations, have shown associations of this lesion with adverse neurodevelopmental outcomes and potentially obstructive lesions of the umbilical cord. We investigated the prevalence of obstetric complications, perinatal disease, and placental abnormalities in cases with FTV. One hundred thirteen cases of placentas with FTV were identified in our pathology database over an 18-year period. Two hundred sixteen placentas without the diagnosis of FTV, frequency matched on year of birth, were selected as controls. Electronic medical records and pathology reports were used to extract maternal and gestational age, method of delivery, neonatal outcome, lesions of the umbilical cord, obstetric complications, and fetal abnormalities. Placentas with FTV were associated with a 9-fold increase in rate of stillbirth and a 2-fold increase in intrauterine growth restriction. The increase in pregnancy-induced hypertension/preeclampsia was not significant when adjusted for maternal and gestational age. Although the rate of potentially obstructive cord lesions was similar in both groups, there was an almost 6-fold increase in the presence of oligohydramnios in FTV placentas, compared with controls. Finally, FTV was associated with a 6-fold increase in fetal cardiac abnormalities. Fetal thrombotic vasculopathy is associated with a significantly higher rate of obstetric and perinatal complications. This study points to abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV.

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“…Prior literature has similarly linked FTV with adverse perinatal outcomes including oligohydramnios, growth restriction, stillbirth, as well as coagulopathy and systemic thrombosis in the newborn (Chisholm and Heerema-McKenney 2015;Saleemuddin et al 2010). Additionally, severe FTV has been connected with intracranial hemorrhage and neurologic impairment of the infant (Chisholm and Heerema-McKenney 2015).…”

Fetal Thrombotic Vasculopathy

“…The incidence of FTV was four times more common in the group with UCA compared to controls (69 vs. 18 cases). This group published a 2nd article outlining complications associated with FTV and found that in term deliveries, cord abnormalities were statistically increased in cases of FTV compared to controls [23]. Avagliano et al [20] analyzed 317 perinatal autopsies and found 32 cases with thrombosed umbilical cord vessels.…”

“…Lepais and colleagues [27] found that mortality in cases of FTV was three times that seen in their control population. Other complications that have shown significant association with FTV include liver injury [14,28], IUGR [13,21,29], intestinal atresia [30], cardiac abnormalities [23], oligohydramnios [23], and major thromboembolic events [1,4,25,27].…”

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“…The most serious outcomes include growth restriction, neurologic injury and perinatal death. 6,7 Our patient with ANA positivity also had foetal thrombotic vasculopathy with superimposed maternal vascular under perfusion and resultant SGA baby. 11,12 Apart from maternal vascular underperfusion, one of the placenta of ITP patient also showed massive perivillous fibrin deposition/maternal floor infarction (MPVFD/MFI).…”