Anemia in a neonate with placental mesenchymal dysplasia

Ishikawa, Satoshi; Morikawa, Mamoru; Umazume, Takeshi; Yamada, Takahiro; Kanno, Hiromi; Takakuwa, Emi; Minakami, Hisanori

doi:10.1002/ccr3.543

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Moreover, MSAFP levels might reflect the degree of placental vasodilation and fetal adverse outcomes; in PMD, fetal erythropoiesis might not adapt to the acute enlargement of the vascular bed, resulting in fetal anemia or FD 15 . In our study, nine patients in whom MSAFP was measured within a week before delivery.…”

Section: Discussionmentioning

confidence: 87%

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series

Kodera

Aoki

Ohba

et al. 2021

J of Obstet and Gynaecol

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Aim This study aimed to evaluate the clinical features and pregnancy outcomes of placental mesenchymal dysplasia (PMD) in Japan. Methods We requested detailed clinical information and placental tissue of PMD cases in 2000–2018 from Japanese facilities with departments of obstetrics and gynecology and analyzed the pregnancy course and neonatal outcomes. Results We collected 49 cases of PMD. Of 18 patients with measured maternal serum alpha‐fetoprotein (MSAFP) levels, 15 (83.3%) had elevated levels. Maternal serum human chorionic gonadotropin (MShCG) levels were transiently elevated in five (17.8%) of 28 patients. Forty‐seven patients continued their pregnancies. All pregnancies were singleton and 40 (85.1%) were associated with adverse events including fetal growth restriction (FGR), threatened premature delivery, fetal demise, and hypertensive disorder of pregnancy in 34 (72.3%), 14 (29.8%), eight (17.0%), and six (12.8%) patients, respectively. Of 47 infants, there were eight stillbirths. There were 40 (85.1%) female infants, and eight (17.0%) had Beckwith–Wiedemann syndrome. Of 39 live births, 23 (59.0%) were associated with premature induction of labor or cesarean section for obstetric indications related to FGR. Eighteen (46.2%) neonates had complications. PMD‐affected placentas were pathologically heterogeneous in both grossly PMD‐affected and non‐affected areas. Conclusions Our study included the largest number of PMD cases with detailed clinical information. PMD is a high‐risk condition for both the mother and the child. Elevated MSAFP levels with normal MShCG levels indicate PMD. Conventional perinatal management of FGR in Japan might be effective in reducing the fetal mortality rate.

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Section: Discussionmentioning

confidence: 87%

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series

Kodera

Aoki

Ohba

et al. 2021

J of Obstet and Gynaecol

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“…The high MSAFP—the principal characteristic of PMD—is the consequence of an increased surface for transfer due to the enlarged placenta and the increased permeability of thin-walled vessels within the stem villi [ 46 , 47 ]. Moreover, the degree of adverse fetal outcomes might correlate with the MSAFP levels [ 46 ]; even in the absence of PMD, approximately 10% of fetuses carried by women with a persisting elevated AFP level ≥2.5 Multiple of the Median (MoM), die in utero [ 9 ]. In PMD, the fetal erythropoiesis might not adjust to the sharp increase in the vascular plate, leading to fetal anemia or adverse outcomes, such as fetal growth restriction, hydrops fetalis, or intrauterine fetal death (IUFD) [ 9 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the degree of adverse fetal outcomes might correlate with the MSAFP levels [ 46 ]; even in the absence of PMD, approximately 10% of fetuses carried by women with a persisting elevated AFP level ≥2.5 Multiple of the Median (MoM), die in utero [ 9 ]. In PMD, the fetal erythropoiesis might not adjust to the sharp increase in the vascular plate, leading to fetal anemia or adverse outcomes, such as fetal growth restriction, hydrops fetalis, or intrauterine fetal death (IUFD) [ 9 , 46 ]. In these cases, intensive monitoring of the Middle Cerebral Artery-Peak Systolic Velocity (MCA-PSV) using ultrasound may be helpful to avoid IUFD in some PMD pregnancies [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Challenging Diagnosis: Placental Mesenchymal Dysplasia—Literature Review and Case Report

et al. 2022

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We describe a 22-year-old woman (2-gravid) case who was referred to our clinic at 18 weeks of gestation for a placenta with vesicular lesions discovered on prenatal examination routine. An ultrasound exam at 31 weeks of gestation showed numerous vesicular lesions, which gradually augmented as the pregnancy advanced. A live normal-appearing fetus was confirmed by intrauterine growth restriction (IUGR). The maternal serum β-human chorionic gonadotropin level remained in normal ranges. At some point, a multidisciplinary medical consensus considered the termination of the pregnancy, but the patient refused to comply. At 33 weeks of gestation, preterm premature rupture of membranes (pPROM) occurred, and she spontaneously delivered a 1600 g healthy female baby with a good long-term outcome. Placental mesenchymal dysplasia (PMD) was retrospectively diagnosed after confronting the data from ultrasound, chorionic villus sampling (CVS), amniocentesis, pathological examination, and immunohistochemical stain. The lack of sufficient reports of PMD determines doctors to be cautious and reserved, approaching these cases more radically than necessary. We reviewed this disease and searched for all cases of PMD associated with healthy, live newborns.

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“…However, PMD is found in 9% of uncomplicated pregnancies [3]. Moreover, several studies also reported abnormal neonatal outcomes such as aneuploidy, Beck-Wiedemann syndrome, hepatic tumor, and hematologic disorders [8][9][10][11][12][13]. Accordingly, prenatal ultrasound indication of thickened placenta with suspicion of placental hemorrhage or PMD should be considered as a high risk pregnancy, which needs close surveillance and follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prenatal sonographic findings and management of placental mesenchymal dysplasia

Luewan,

Chaksuwat,

Pongsuvareeyakul

et al. 2021

Clin. Exp. Obstet. Gynecol.

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Placental mesenchymal dysplasia (PMD) is a rare disorder of the placenta characterized by placentomegaly with di fuse hydropic stem villous, aneurysmally dilated vessels, and lack of trophoblastic proliferation. Case: The prenatal ultrasound of a 34-year-old woman (G1P0) at 33 weeks of gestation showed an enlarged placenta with multiple cystic lesions, heterogeneous echoes with no active blood low, and fetal growth restriction (FGR). The di ferential diagnosis involved partial mole, placental hemorrhage, and PMD. She developed preeclampsia at 38 weeks of gestation and gave birth to a normally formed, growth-restricted baby. The placenta, weighing 785 g, showed scattered cystic vesicles in the parenchyma. The histology shows enlarged edematous stem villi with occasional cistern formation and no area of chorioangioma or features of molar pregnancy. PMD associated fetal growth restriction was diagnosed. Conclusion: PMD has prenatal ultrasound result resembling those of partial mole, placental hemorrhage and chorioangioma, but the fetus is phenotypically normal. Nevertheless, fetal surveillance is essential.

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Anemia in a neonate with placental mesenchymal dysplasia

Cited by 11 publications

References 13 publications

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series

A Challenging Diagnosis: Placental Mesenchymal Dysplasia—Literature Review and Case Report

Prenatal sonographic findings and management of placental mesenchymal dysplasia

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