From the Guidelines
In fetal demise due to preeclampsia, placental parenchymal infarction is the most likely placental finding. Preeclampsia is characterized by maternal hypertension and systemic endothelial dysfunction that significantly affects the placenta. The disease process causes inadequate remodeling of maternal spiral arteries, leading to reduced placental perfusion 1. This poor perfusion results in areas of ischemia within the placenta that can progress to frank infarction, where portions of placental tissue die due to insufficient blood supply. These infarcts appear as well-demarcated, firm, pale or white areas within the placental parenchyma. While avascular villi can occur in various placental pathologies, they are not the predominant finding in preeclampsia-related fetal demise. Instead, the extensive placental infarctions directly contribute to placental insufficiency, reducing the functional capacity of the placenta to support fetal growth and development, ultimately leading to fetal compromise and potential demise in severe cases.
Key Points
- Preeclampsia is a disease of placentation/placental dysfunction, and the fetus is potentially vulnerable to the effects of uteroplacental insufficiency 1.
- The ideal scanning schedule for fetal biometry, amniotic fluid volume assessment, and fetal Doppler waveform analysis should be determined by the presence or absence of fetal growth restriction at the initial assessment and the gestation at diagnosis 1.
- Placental infarctions are a common finding in preeclampsia, and they can lead to placental insufficiency and fetal compromise 1.
- The management of preeclampsia includes prevention of severe hypertension and the possibility of prolonging gestation to allow the fetus more time to mature before delivery 1.
Placental Pathology
The placental pathology in preeclampsia is characterized by inadequate remodeling of maternal spiral arteries, leading to reduced placental perfusion 1. This poor perfusion results in areas of ischemia within the placenta that can progress to frank infarction. The infarcts appear as well-demarcated, firm, pale or white areas within the placental parenchyma. While avascular villi can occur in various placental pathologies, they are not the predominant finding in preeclampsia-related fetal demise.
Clinical Implications
The clinical implications of placental parenchymal infarction in preeclampsia are significant, as it can lead to placental insufficiency and fetal compromise. The management of preeclampsia should include close monitoring of fetal growth and well-being, as well as the prevention of severe hypertension and the possibility of prolonging gestation to allow the fetus more time to mature before delivery 1.
From the Research
Placental Findings in Fetal Demise due to Preeclampsia
The most likely placental findings in fetal demise due to preeclampsia can be understood by examining the effects of preeclampsia on placental development and function.
- Preeclampsia is characterized by inadequate placental trophoblast invasion of the maternal uterine spiral arteries, leading to poor placental perfusion and placental ischemia 2.
- This ischemia can result in the release of factors into the maternal circulation, causing widespread activation or dysfunction of the maternal endothelium 2.
- Placental lesions of vascular insufficiency, such as infarcts, are associated with an anti-angiogenic state in women with preeclampsia 3.
- Avascular villi are also more frequent in preeclampsia than in spontaneous prematurity, suggesting a link between preeclampsia and placental vascular lesions 4.
Comparison of Avascular Villi and Placental Parenchymal Infarction
- Avascular villi are characterized by a lack of blood vessels in the placental villi, which can lead to impaired gas and nutrient exchange between the mother and fetus 4.
- Placental parenchymal infarction, on the other hand, refers to the death of placental tissue due to inadequate blood supply, which can be a result of preeclampsia 5, 3.
- While both avascular villi and placental parenchymal infarction can be associated with preeclampsia, the available evidence suggests that placental parenchymal infarction is more directly related to the pathophysiology of preeclampsia 5, 3.
Most Likely Placental Finding
- Based on the available evidence, the most likely placental finding in fetal demise due to preeclampsia is placental parenchymal infarction, as it is more directly related to the pathophysiology of preeclampsia 5, 3.
- However, avascular villi are also a common finding in preeclampsia and can contribute to impaired placental function and fetal demise 4.