Rare placental lesion linked to high risk for fetal and newborn complications

Fetal thrombotic vasculopathy (FTV), a rare lesion of the placenta marked by regional avascular villi and often accompanied by thrombosis in placental fetal vessels, greatly increases the risk of adverse perinatal outcomes such as stillbirth or intrauterine growth restriction, researchers report.

Using 18 years of electronic medical records and pathology reports as well as placental slides, researchers from Brigham and Women’s Hospital, Boston, collected data on 113 cases of FTV and 216 controls without the lesion to determine the prevalence of obstetric complications and adverse outcomes in the immediate neonatal period. They found a nearly 9-fold increase in the rate of stillbirth and a 2-fold increase in intrauterine growth restriction among cases of FTV compared with controls as well as a 6-fold increase in both oligohydramnios and fetal cardiac abnormalities. Trends in the data also suggested a likely association between FTV and potentially obstructive umbilical cord lesions later in gestation.

The study findings point to “abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV,” the authors write.

In addition to data on obstetric complications and neonatal outcomes, the researchers collected information about maternal and gestational age and method of delivery. Women in the FTV group were older than control women, had a higher rate of cesarean delivery, and were more likely to have a preterm birth. Placentas in the FTV group were significantly smaller than in the controls.

Although previous studies have linked FTV with neurodevelopmental abnormalities, the authors note that they didn’t find perinatal central nervous system abnormalities, perhaps because of limited available neonatal records and lack of patient follow-up. They call for a prospective study, including “comprehensive periodic neurologic examinations” to assess for central nervous system and neurodevelopmental abnormalities, which may not show up until later in childhood.

The study was published in Pediatric and Developmental Pathology (2010;13[6]:459-464).