Massive perivillous fibrin deposition
Other namesMPFD, MFD
SpecialtyObstetrics, pathology
Symptomsnone
Causesunknown, may be autoimmune
Risk factorsprevious MPFD
Diagnostic methodhistology of the placenta
Treatmentnone
Prognosis33% premature birth, 31% neonatal death
Frequency0.028% of all pregnancies, 18-50% recurrence in those affected

Massive perivillous fibrin deposition (MPFD, or MFD) refers to excessive deposition of fibrous tissue around the chorionic villi of the placenta. It causes reduced growth of the foetus, and leads to miscarriage in nearly 1 in 3 pregnancies affected. There are typically no symptoms, and it is rarely detected before birth. The cause is unknown, but may be autoimmune. Diagnosis is based on the histology (cell appearance) of the placenta. There are currently no known treatments. MPFD is very rare, but recurrence is around 18% in those affected.

Signs and symptoms

There may be no symptoms of MPFD. Doppler ultrasound of the umbilical arteries may not detect reduced blood flow, particularly if a case is not severe.[1][2]

Cause

The cause of MPFD is unknown.[3] Current theories suggest an autoimmune cause.[2][3] It is associated with sepsis, intraventricular haemorrhage of the brain, and necrotising enterocolitis in the baby.[1] It may also be linked to maternal syphilis infection,[4] and antiphospholipid syndrome,[5] among other conditions.[6][7]

Mechanism

MPFD is caused by deposition fibrous tissue around the chorionic villi of the placenta.[1][3] The placenta often shows lesions upon histology and autopsy.[8] The villi become trapped, causing avascular necrosis.[1] This causes reduced substance exchange, and movement of the placenta.[1] This can cause reduce growth of the foetus, and may lead to miscarriage.[3]

Diagnosis

MPFD is diagnosed based on histological examination of the chorionic villi of the placenta.[8] This diagnostic process is difficult, as there is great variety in appearance, and an overlap in signs with maternal floor infarction.[9]

Prognosis

MPFD always causes reduced foetal growth.[10] It causes premature birth in 33% of pregnancies, and neonatal death in 31% of pregnancies.[10]

Treatment

There are currently no widespread treatments for MPFD.[11] There is anecdotal evidence of successful use of pravastatin to reverse MPFD during pregnancy.[11]

Epidemiology

MPFD is very rare.[3] Incidence is estimated to be around 0.028%, or around 1 in 3,500 pregnancies.[10] It may account for 12% of pregnancies where foetal growth is restricted.[1] It shares symptoms with maternal floor infarction. In mothers who have already experienced it, there is a high risk of recurrence. Recurrence may be around 18%,[10] although in cases where miscarriage occur in the first trimester, it may be as high as 50%.[9]

References

  1. 1 2 3 4 5 6 Spinillo, Arsenio; Gardella, Barbara; Muscettola, Giulia; Cesari, Stefania; Fiandrino, Giacomo; Tzialla, Chryssoula (November 2019). "The impact of placental massive perivillous fibrin deposition on neonatal outcome in pregnancies complicated by fetal growth restriction". Placenta. 87: 46–52. doi:10.1016/j.placenta.2019.09.007. PMID 31546153. S2CID 202747162.
  2. 1 2 Devisme, Louise; Chauvière, Claire; Franquet-Ansart, Hélène; Chudzinski, Anastasia; Stichelbout, Morgane; Houfflin-Debarge, Véronique; Subtil, Damien (April 2017). "Perinatal outcome of placental massive perivillous fibrin deposition: a case-control study". Prenatal Diagnosis. 37 (4): 323–328. doi:10.1002/pd.5013. PMID 28152557. S2CID 12908009.
  3. 1 2 3 4 5 Faye-Petersen, Ona Marie; Ernst, Linda M. (March 2013). "Maternal Floor Infarction and Massive Perivillous Fibrin Deposition". Surgical Pathology Clinics. 6 (1): 101–14. doi:10.1016/j.path.2012.10.002. PMID 26838705.
  4. ↑ Taweevisit, Mana; Thawornwong, Nutchanok; Thorner, Paul Scott (2021-01-01). "Massive Perivillous Fibrin Deposition Associated With Placental Syphilis: A Case Report". Pediatric and Developmental Pathology. 24 (1): 43–46. doi:10.1177/1093526620957523. PMID 32951526. S2CID 221826726.
  5. ↑ Sebire, Neil J; Backos, May; Goldin, Robert D.; Regan, Lesley (May 2002). "Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome". BJOG. 109 (5): 570–3. doi:10.1111/j.1471-0528.2002.00077.x. PMID 12066949. S2CID 33748717.
  6. ↑ Hung, Noelyn Anne; Jackson, Christopher; Nicholson, Martha; Highton, John (February 2006). "Pregnancy-related poymyositis and massive perivillous fibrin deposition in the placenta: are they pathogenetically related?". Arthritis and Rheumatism. 55 (1): 154–6. doi:10.1002/art.21710. PMID 16463429.
  7. ↑ Gestrich, Catherine K; Zhou, Yi Yuan; Ravishankar, Sanjita (2021-01-01). "Massive Perivillous Fibrin Deposition in Congenital Cytomegalovirus Infection: A Case Report". Pediatric and Developmental Pathology. 24 (1): 47–50. doi:10.1177/1093526620961352. PMID 33104416. S2CID 225083262.
  8. 1 2 Pathak, Sangeeta; Lees, Christoph C.; Hackett, Gerald; Jessop, Flora; Sebire, Neil J. (December 2011). "Frequency and clinical significance of placental histological lesions in an unselected population at or near term". Virchows Archiv. 459 (6): 565–72. doi:10.1007/s00428-011-1157-z. PMID 22038509. S2CID 26004303.
  9. 1 2 Katzman, Philip J.; Genest, David R. (2002-03-01). "Maternal floor infarction and massive perivillous fibrin deposition: histological definitions, association with intrauterine fetal growth restriction, and risk of recurrence". Pediatric and Developmental Pathology. 5 (2): 159–64. doi:10.1007/s10024001-0195-y. PMID 11910510. S2CID 43397786.
  10. 1 2 3 4 Bane, Anita L.; Gillan, J. E. (March 2003). "Massive perivillous fibrinoid causing recurrent placental failure". BJOG. 110 (3): 292–5. doi:10.1016/S1470-0328(03)00919-4. PMID 12628270.
  11. 1 2 Chaiworapongsa, Tinnakorn; Romero, Roberto; Korzeniewski, Steven J.; Chaemsaithong, Piya; Hernandez-Andrade, Edgar; Segars, James H.; DeCherney, Alan H.; McCoy, M. Cathleen; Kim, Chong Jai; Yeo, Lami; Hassan, Sonia S. (March 2016). "Pravastatin to prevent recurrent fetal death in massive perivillous fibrin deposition of the placenta (MPFD)". The Journal of Maternal-Fetal & Neonatal Medicine. 29 (6): 855–62. doi:10.3109/14767058.2015.1022864. PMC 4710361. PMID 25893545.
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