Massive perivillous fibrinoid causing recurrent placental failure


* Dr A. L. Bane, Department of Pathology & Laboratory Medicine, Mt Sinai Hospital, Toronto M5G 1X5 Canada.


Objective To establish the incidence, recurrence rate and consequences of massive perivillous fibrinoid.

Design Retrospective analysis of the histology of all placentas with a diagnosis of massive perivillous fibrinoid between 1991 and 1998, together with the maternal case records.

Setting The histopathology department of the Rotunda Hospital, Dublin, Ireland.

Population A relatively homogeneous group of pregnant women in the northern part of Dublin City, which is the catchment area for the Rotunda Hospital, delivered between 1991 and 1998.

Methods Retrospective review of archival placental pathology and maternal charts.

Main outcome measures The incidence of massive perivillous fibrinoid, perinatal outcome and recurrence rate.

Results The incidence of massive perivillous fibrinoid was 0.028%, with a recurrence rate of approximately 18%. All the infants suffered intrauterine growth restriction; there was a 31% fetal loss rate and a 33% preterm delivery rate.

Conclusions Massive perivillous fibrinoid is associated with intrauterine death, intrauterine growth restriction and preterm delivery. It has a significant recurrence rate and both the clinical findings of intrauterine growth restriction and the postmortem findings imply a syndrome of chronic placental insufficiency.