Placental massive perivillous fibrin deposition after a previous uncomplicated term pregnancy : report of two cases

Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) are rare and poorly understood placental lesions often leading to preterm delivery, intrauterine fetal growth restriction (IUGR), and fetal death. An association between MPFD and thrombophilia has been reported. Here, we report two cases in which MPFD followed a previous uncomplicated term pregnancy. MPFD was diagnosed on the basis of standard criteria (transmural fibrinoid deposition). Case 1 was a 33-year-old woman who presented with IUGR at 21 weeks; intrauterine fetal death occurred at 25 weeks. Case 2, a 32-year-old woman, noted reduced fetal movements and was diagnosed with IUGR at 29 weeks. Despite immediate cesarean section, the newborn survived for just a few days. Autopsy showed no abnormalities in either fetus. Placental histology showed villi (>60% of placental mass in both cases) entrapped by large amounts of deposited fibrinoid material. Neither woman had a medical history of autoimmune disease or any blood coagulation disorder. Complete thrombophilia screening was not performed. Our data show that MPFD may occur in women after a previous normal term pregnancy. Given the high reported recurrence rate (~50%) of this placental pathology, further pregnancies should be considered at risk of MPFD. Women should be tested for thrombophilia in order to improve the management and fetal outcome of subsequent pregnancies.