Maternal floor infarction

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Maternal floor infarction, abbreviated MFI, is a pathology of the placenta.

It is formally known as placental maternal floor infarction. It is also known as massive perivillous fibrin deposition.[1]

General

  • Not a true infarct.
    • It is really fibrin deposition.[2]

Associations:

Gross

Features:[7]

  • +/-Thickened placenta.
  • Maternal aspect of placental disc irregular or lobulated appearance.
  • +/-Yellowish discolourization.

Microscopic

Features:

  • Extensive fibrin deposition around villi on maternal aspect - see: Perivillous fibrin deposition.
    • Described as having a "net-like" pattern.[7]
    • "Extensive" - either of the following:[4][8]
      1. Micro: one slide with >50% of villi involved.
        • Gross: full thickness involvement.
      2. Micro: maternal floor has at least 3 mm of fibrin on one slide.
        • Gross: maternal floor diffusely involved.

DDx:

Images

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PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- FETAL MEMBRANES WITHIN NORMAL LIMITS.
- SMALL PLACENTAL DISC WITH MASSIVE PERIVILLOUS FIBRIN DEPOSITION, SEE COMMENT.

COMMENT:
Massive perivillous fibrin deposition (MPVFD) is associated with intrauterine 
growth restriction (IUGR). MPVFD is described in association with in 
anti-phospholipid antibody (APLA) syndrome, pregnancy-induced hypertension and 
congenital infections. Perivillous fibrin deposition may be seen in diabetes.

There is no apparent infection. Changes suggestive of decidual vasculopathy 
are not apparent. Changes suggestive of fetal thrombotic vasculopathy are 
not identified.

See also

References

  1. Baergen, Rebecca N. (2011). Manual of Pathology of the Human Placenta (2nd ed.). Springer. pp. 367. ISBN 978-1441974938.
  2. Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 178. ISBN 978-0387744858.
  3. Roberts, DJ.; Post, MD. (Dec 2008). "The placenta in pre-eclampsia and intrauterine growth restriction.". J Clin Pathol 61 (12): 1254-60. doi:10.1136/jcp.2008.055236. PMID 18641412.
  4. 4.0 4.1 Katzman, PJ.; Genest, DR.. "Maternal floor infarction and massive perivillous fibrin deposition: histological definitions, association with intrauterine fetal growth restriction, and risk of recurrence.". Pediatr Dev Pathol 5 (2): 159-64. doi:10.1007/s10024-001-0195-y. PMID 11910510.
  5. 5.0 5.1 Sebire NJ, Backos M, Goldin RD, Regan L (May 2002). "Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome". BJOG 109 (5): 570–3. PMID 12066949. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2002&volume=109&issue=5&spage=570.
  6. Kanfer, A.; Bruch, JF.; Nguyen, G.; He, CJ.; Delarue, F.; Flahault, A.; Nessmann, C.; Uzan, S. (Jan 1996). "Increased placental antifibrinolytic potential and fibrin deposits in pregnancy-induced hypertension and preeclampsia.". Lab Invest 74 (1): 253-8. PMID 8569189.
  7. 7.0 7.1 Baergen, Rebecca N. (2011). Manual of Pathology of the Human Placenta (2nd ed.). Springer. pp. 368. ISBN 978-1441974938.
  8. AFIP - Placental Pathology. P.135. ISBN: 1-881041-89-1. 2004.