Infarcted Placenta - what does it mean for you and your baby?

This page is part of the Home Birth Reference Site, but is relevant to anybody interested in placental infarcts. I have tried to explain the subject in plain English and to provide references and links to more information. I am not a doctor or a midwife - my brief is to help provide information to enable mothers to make informed choices.

Does anyone have any light to shed on whether having had an infarcted placenta at 39 weeks in my first pregnancy has any implications for subsequent pregnancies? I just don't understand the significance (if any). V.

V, I didn't have any idea what an infarcted placenta was, but I've just spent some time researching it and it's really interesting. You've probably found out a lot about it already, but maybe some of this will be useful to you.

Placental infarcts are scarred areas of the placenta caused by inadequate blood supply. They are strongly associated with pregnancy-induced hypertension (PIH) and with growth-restricted babies. Several studies have found a direct correlation between the degree of PIH and the amount of infarction of the placenta - see Udainia et al (2004) . Infarcts are also found in 25 - 30% of normal, term pregnancies and as long as they do not cover a large amount of the placental surface, they are not normally associated with any problems in these cases. However, infarcts are found in nearly all cases of moderate or severe PIH.

Nothing I found discussed the likelihood of recurrence, but did any of the above ring any bells with you? Did you suffer from high blood pressure in your last pregnancy? Or this one? Was your daughter small for dates? Did she go into distress during labour? I think that looking at these risk factors probably gives you your best shot at info relevant to this pregnancy. One of the web pages listed below suggests that ultrasound scanning or colour doppler imaging can detect infarcts. How would you feel about a detailed scan for placental function?

This topic has led me to some really interesting websites which lots of list members might find useful. One of the best was Placental Triage 101, which gives you a guided tour of the placenta and its development, with lots of photos, and discussions of various abnormalities.

(http://showcase.netins.net/web/placenta/placentaltriage101.htm)

Definition of Placental Infarcation

From Encyclopaedia Britannica
(www.britannica.com/eb/article-76092)

Infarction is degeneration and death of a tissue and its replacement with scar tissue. Small yellowish-white deposits of fibrin (a fibrous protein), caused by interference with the maternal circulation, occur normally in the placenta as pregnancy progresses. The fetus usually is not affected by infarction of the placenta unless the process is extensive.

Photo of an infarct from Utah Medlib
(http://medlib.med.utah.edu/WebPath/PLACHTML/PLAC023.html)

I've copied below a few abstracts which were relevant.

What I found especially interesting is that Naeye (1977) found that women were more likely to have this feature in a placenta if their haemoglobin level was over 12g/100ml. So we have women being told to take iron supplements to try to raise their Hb level to the non-pregnant average of over 12, but in fact such a rate may be associated with some increased risks. Very interesting.

I hope that you are OK and that we will see a birth announcement from you soon,

Angela Horn

References

Udainia et al (2004) - J.Anat.Soc.India 53 (1) 27-30 (2004)
Relation between placental surface area, infarction and foetal distress in PIH
http://www.medind.nic.in/jae/t04/i1/jaet04i1p27.pdf

Naeya (1977):

Obstet Gynecol. 1977 Nov;50(5):583-8. Related Articles, Links Placental infarction leading to fetal or neonatal death. A prospective study. Naeye RL.

The pathogenesis of perinatal death due to placental infarction was analyzed in a large prospective study that included more than 1000 medical, demographic, hereditary, and postmortem variables. The disorder was the fifth most frequent cause of death in the study with a perinatal mortality of 2.26/1000 births. Its frequency was directly correlated with the gravidas' blood pressures, an effect augmented by albuminuria and work during pregnancy. Fatal infarcts were increased 20-fold with glomerulonephritis, fivefold with abruptio placentae, and twofold when the gravidas' hemoglobins were over 12 g/100 ml. Maternal weight gains were suboptimal and the involved neonates had a pattern of growth retardation characteristic of undernutrition. The disorder was more frequent when the gravida had made few prenatal visits for medical care and had had prior unsuccessful pregnancies.

PMID: 909664 [PubMed - indexed for MEDLINE]

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J Med Assoc Thai. 2006 May;89(5):594-9.
Prevalence of placental pathology in low birthweight infants.
Kleebkaow P, Limdumrongchit W, Ratanasiri T, Komwilaisak R, Seejorn K.

Department of Obstetrics and Gynecology, Faculty of Medicine, Khon
Kaen University, Thailand. Kpilai@kku.ac.th

OBJECTIVE: To determine the prevalence of placental pathology among
low birthweight infants delivered at Srinagarind Hospital. MATERIAL
AND METHOD: Descriptive study of 114 placentas from infants weighing
between 500 and 2,499 grams delivered between June 2002 and June 2004
in the labour room, Srinagarind Hospital. Placentas from low
birthweight infants were examined by a perinatal pathologist in the
surgical pathology room, department of pathology, faculty of medicine,
Khon Kaen University. The demographic data of the mothers, the
gestational age of the infants by obstetric information and according
to the Ballard score and placental examinations were collected and
analyzed. The placental examinations included both macroscopic and
microscopic studies. RESULTS: The prevalence of placental pathology in
low birthweight infants was 80.7%. The four types of placental
pathology were an increased placental to fetal weight ratio,
infarction, vascular abnormalities of the decidua, and inflammation in
64.1, 30.4, 20.6 and 18.5 percent, respectively. CONCLUSION: All
placentas of low birthweight infants should be studied for potential
pathologies.

PMID: 16756042 [PubMed - in process]

============
Placenta. 2002 Apr;23(4):343-51. Related Articles, Links

The epidemiology of placental infarction at term.

Becroft DM, Thompson JM, Mitchell EA.

Department of Paediatrics, University of Auckland, Auckland, New Zealand.

The incidence and associations of placental infarction at term were
investigated as part of a population based case-control study of small for gestational age (SGA) infants. 509 placentas from women delivering SGA infants (SGAP) and 529 placentas from women delivering infants with birthweights appropriate for gestational age (AGAP) were examined using fixed protocols for macroscopic identification and microscopic confirmation of infarction. Other information was obtained by maternal interview and from an obstetric database.Infarcts were found in 17.3 per cent of SGAP and 11.7 per cent of AGAP. This difference was in placentas with multiple infarcts not involving the placental margin and was significant in multivariate analysis (OR 1.66; 95 per cent CI 1.12,2.47). Multivariate analysis showed significant associations between the presence of any infarct and maternal hypertension in both SGAP (OR=4.00; 95 per cent CI 1.96,8.16) and AGAP (OR 2.99; 95 per cent CI 1.23,7.32); maternal smoking, associated with a lesser risk in SGAP only (OR=0.31; 95 per cent CI 0.13,0.73); maternal age at first pregnancy in a linear relationship with AGAP only (beta co-efficient 0.09, P=0.0034); and between some ethnic groups. We conclude that at least five factors have independent associations with the incidence of placental infarction and these associations differ by site and age of infarcts.
Copyright 2002 Elsevier Science Ltd.

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Links

Websites with info on placental pathology:

http://radiology.uchc.edu/eAtlas/GYN/1201.htm

http://medlib.med.utah.edu/WebPath/PLACHTML/PLAC023.html (photo) from Placental Pathology photos
Pics of all sorts of placentas http://medlib.med.utah.edu/WebPath/PLACHTML/PLACIDX.html#4

http://radiology.uchc.edu/eAtlas/GYN/1201.htm

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