Early Path Medical Consultation Services

Early Path Medical Consultation Services
Pathology Services Working for Safer Pregnancies

CASE 1: This 32 year old woman presented at 32 weeks for evaluation of decreased fundal height. Ultrasonography showed oligohydramnios, fetal biometry at the 5th percentile, and absent end-diastolic flow on umbilical artery Doppler velocimetry. After one course of antenatal steroids, delivery was induced for non-reassuring fetal testing. The 180 gram placenta showed uteroplacental vessels with absent physiologic conversion, fibrinoid necrosis/atherosis and chronic vasculitis. Small distal villi were fibrotic and poorly vascularized. This is a "typical" case of preterm preeclampsia with chronically abnormal uteroplacental vascular conversion, with a small placenta, defective arborization, reduced placental nutrient transport capacity and fetal compromise.

CASE 2: This 28 year old woman with two previous preeclamptic pregnancies presented at 29 weeks’ gestation with complaints of headache and excessive weight gain. Physical examination and admission laboratory tests confirmed a diagnosis of severe preeclampsia, with thrombocytopenia and elevated liver enzymes. Fetal biometry showed all measurements to be at or greater than the 60th percentile for gestational age. The patient was induced for maternal indications and delivered a viable infant. The 340 gram placenta (normal to large for gestational age) demonstrated diffuse chronic marginating choriodeciduitis with dense decidual plasma cell infiltrates. Multifocal uteroplacental thrombi were accompanied by subacute placental abruption. When preeclampsia is recurrent, the possibility of maternal subclinical auto/allo-immune pathology, as well as underlying renal or metabolic disease, should be considered. In comparison to Case 1, this placenta showed normal development until the apparently acute onset of uteroplacental thrombosis. At 2 months post partum, she was found to have phospholipid antibodies. We have found thrombosis of otherwise structurally normal uteroplacental vessels plus plasma cells to be common in the phospholipid antibody syndrome. When vascular pathology is accompanied by chronic inflammatory lesions, simple anticoagulation may not be effective, if the principal drive to tissue injury is immune in nature. This type of evaluation of the underlying processes of tissue injury in a compromised pregnancy are obviously useful when a treatment appears to have "failed"; histology may show that treatment was rather misdirected to trying to remedy a symptom of a very different principal disease.

DISCLAIMER: This communication is for educational purposes only and it is not to be used as a substitute for a consultation with your physician. Should you contact Dr. Salafia's office, any responses to you will be based on the information you provide and no attempt will be made to confirm or verify any such information, including any laboratory data you may submit. Questions regarding actual symptoms of illness or health conditions should be addressed to a local health care practitioner who can physically examine and take responsibility for your care throughout the course of your condition/illness, which Dr. Salafia, being a physician licensed to practice medicine only in the State of New York, cannot and will not do. You should NOT use this information to diagnose or treat a health problem; rather, you should consult a qualified health care provider who examines you in person and who is licensed to practice in the state where you are located.