Placental infarction

Placental infarction refers to a localized area of ischemic villous necrosis. It is a significant cause of placental insufficiency. 

Epidemiology

A localized infarction can occur in up to ~25% of all placental pathologies and approximately 5-20% of all gestations (on average 12.5%) ⁶. 

Pathology

It usually results from an interrupted maternal blood supply

Location

Placental infarcts are more common at the periphery of the placenta.

Associations

• post-term pregnancies
• maternal hypertension
• retroplacental hemorrhage
• other maternal medical conditions
  • anticardiolipin antibodies
  • chronic nephritis
  • systemic lupus erythematosus (SLE)
  • diabetic microangiopathy

Radiographic features

Antenatal ultrasound

Most placental infarcts are difficult to diagnose on ultrasound, unless hemorrhagic in nature ⁶. They may on occasion be seen as a hypoechoic region with thick hyperechoic rim and/or as a well-circumscribed mixed/hyperechoic pattern mass.

Treatment and prognosis

Those that occur at the placental margins are usually of no clinical significance at this location.

Growth restriction is often present if 15% or more of placental tissue is involved.

An infarction in the first or second trimester within the center of the placenta or with extensive involvement of the placenta (more than 50%) is much more concerning and may lead to fetal death.

Complications

Intrauterine growth retardation, fetal death, and recurrent abortion have been associated with large (>10% of parenchyma) or early-onset infarctions.

See also

• placental insufficiency