Dichorionic Twins Discordant for Massive Perivillous Fibrinoid Deposition: Report of a Case and Review of the Literature

Abstract

Massive perivillous fibrinoid deposition (MFD) and maternal floor infarction (MFI) are lesions of unknown etiology associated with poor perinatal outcomes, including fetal intrauterine growth restriction and neurodevelopmental injury, high risks of pregnancy loss, and recurrence in subsequent gestations. MFI comprises massive intervillous fibrinoid deposition concentrated at the maternal floor. MFD is a similar lesion but is diffuse within the parenchyma. MFD/MFI lesions represent a spectrum of severity of cloak-like perivillous fibrinoid deposition, and there is mounting evidence that, often, they represent sequelae of immune-mediated phenomena and/or an imbalance in factors that normally maintain the fluidity of blood in the maternal space. There are only a handful of reported instances of discordant MFD/MFI occurrence in twin placentas. We present a fourth such occurrence in a fused, dichorionic diamniotic twin placenta and submit that our dizygotic twin gestation case provides additional supportive evidence that immune-mediated mechanisms are involved in the formation of pathological accumulations of fibrinoid, at least in some cases.

One-sided chronic intervillositis of unknown etiology in dizygotic twins: a description of 3 cases

“…Several histopathological findings in the placenta are associated with FGR such as CIUE, VUE, massive peri-villous fibrin depositions, and fetal thrombosis [12]. One-sided VUE or MPFD in association with FGR have been described in previous studies of dizygotic twins [13][14][15][16][17][18][19]. In our twin cases, the presence of CIUE, with or without peri-villous fibrin deposits or VUE, was also related to a lower birthweight.…”

One-Sided Chronic Intervillositis of Unknown Etiology in Dizygotic Twins: A Description of 3 Cases

“…Several histopathological findings in the placenta are associated with FGR such as CIUE, VUE, massive peri-villous fibrin depositions, and fetal thrombosis [ 12 ]. One-sided VUE or MPFD in association with FGR have been described in previous studies of dizygotic twins [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In our twin cases, the presence of CIUE, with or without peri-villous fibrin deposits or VUE, was also related to a lower birthweight.…”

Fetal akinesia deformation sequence and massive perivillous fibrin deposition resulting in fetal death in six fetuses from one consanguineous couple, including literature review

“…This leads to the conclusion that MPFD is not only associated with maternal factors influencing the vascular system through chronic endothelial damage (obesity, autoimmune disease, diabetes mellitus) or acute damage during viral infections (coxsackie virus A9/A16, cytomegaly virus, SARS-COV-2). Furthermore, from the literature search, the unexpected reports on four discordant twins with one normal placenta and one abnormal supports the theory that it is not simple maternal influence causing the MPFD (Faye-Petersen et al, 2018;Feist et al, 2015;Gupta et al, 2004;Redline et al, 2003). Unfortunately, in the literature search from the 129 eligible articles only 63 could be included to relate MPFD with fetal outcome.…”

“…Of these, 12 could not be included because no full text was available. After reading the full text of all of the remaining articles, 63 were included (Abdulghani et al, 2017 ; Achuthan et al, 2017 ; Adams‐Chapman et al, 2002 ; Al‐Adnani et al, 2008 ; Al‐Sahan et al, 2014 ; Ananthan et al, 2019 ; Andres et al, 1990 ; Bane & Gillan, 2003 ; Batcup et al, 1985 ; Bendon & Hommel, 1996 ; Benirschke et al, 2000 ; Brown et al, 2002 ; Chaiworapongsa et al, 2016 ; Chang et al, 2006 ; Chisholm et al, 2016 ; Clewell & Manchester, 1983 ; da Cunha Castro & Popek, 2007 ; Devisme et al, 2017 ; Eom et al, 2008 ; Faye‐Petersen et al, 2018 ; Feist et al, 2015 , 2019 , 2020 ; Gao et al, 2021 ; Gestrich et al, 2020 ; Gibbins et al, 2020 ; Griffin et al, 2012 ; Gupta et al, 2004 ; Hannaford et al, 2019 ; He et al, 2018 ; Heller et al, 2016 ; Hung et al, 2006 ; Jaiman et al, 2020 ; Katz et al, 1987 , 2002 ; Kim et al, 2019 ; Leavey et al, 2019 ; Leong et al, 2013 ; Linn et al, 2013 ; Makino et al, 2004 ; Maloney & Baergen, 2010 ; Man et al, 2016 ; Mandsager et al, 1994 ; Matern et al, 2001 ; Minamoto et al, 2019 ; Mongula et al,…”