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| Placental Infarct |
| Etiology •Decidual vascular thrombosis or •Absence or abnormal conversion of decidual vessels or •Fibrinoid necrosis and atherosis of decidual vessels •Can lead to a cessation in blood supply to intervillous space and subsequent collapse of villous architecture and agglutination of villi |
| Pathogenesis •Cessation of blood supply to intervillous space and subsequent collapse of villous architecture and agglutination of villi with death of villous trophoblast followed by death of villous stroma and fetal vessels, |
| Epidemiology •Marginal infarcts (<1cm) present in 10% of normal term deliveries •More significant number and size of infacts seen in preclampsia, intrauterine growth retardation, anti-phospholipid antibody syndrome |
| General Gross Description •Acute infarcts (2-3 days old) usually red and firm •Subacute infarct (3-5 days old) usually pink-tan and firm •Old infarcts usually white-tan and firm •Wedge shaped with apex at maternal surface •Can be located marginally or centrally •Can range in size from small to massive |
| General Microscopic Description •Acute infarcts (2-3 days old) show collapse of intervillous space. Villi appear to agglutinate and have lost their outer trophoblast layer, but fetal vasculature can still remain or be degenerating with intervillous hemorrhage. •Old infarcts have virtually no blood in intervillous space and villi have no nuclei whatsoever with pale pink outlines of their shape. These are the so calledd "ghost villi". •Subacte infarcts have microscopic features intermediate between acute and old infarcts |
| Clinical Correlation •Small infarcts are usually asymptomatic •Multiple infarcts associated with preeclampsia or severe hypertension may involve enough of placental parenchyma to lead to fetal demise |
| References •Salafia and Popek "Placenta" (Chaper 69) in Damjanov and Linder (eds) Anderson's Pathology 10th edition, St Louis: Mosby, 1996, p2317. •Cunningham et al Williams Obstetrics, Norwalk: Appleton and Lange, 1993, p742-744. |
| Placental Infarct |
| Synopsis by: Linda Ernst (T88100M54700)[225] |
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