Early‐onset severe growth restriction and placental abruption associated with Breus mole

Abstract

An 18-year-old primigravida with raised α-fetoprotein levels at 15 weeks of pregnancy displayed reduced amniotic fluid volume (amniotic fluid index [AFI], 11 cm) and bulky placenta at her 20-week mid-trimester scan.A repeat scan at 24 + 6 weeks showed reduced AFI (13 cm), absent end diastolic flow, bulky placenta, and no fetal growth-with significant asymmetric growth restriction (estimated fetal weight, 341 g) (Fig. 1). Because of early-onset severe growth restriction and absent end diastolic flow, the woman was informed of the poor fetal prognosis and received 2 doses of steroid to enhance pulmonary maturity.She subsequently presented to the delivery suite at 25+ 2 weeks of pregnancy with membrane rupture and mild vaginal bleeding. Abdominal and speculum examination revealed findings indicative of placental abruption. Scan showed fundal placenta with significant surrounding blood and absent fetal heartbeat. After initial resuscitation, labor was induced with misoprostol, and a stillborn male infant weighing 268 g was delivered. The woman received 3 units of blood post-delivery owing to a hemoglobin level of 6.4 g. The postnatal period was uneventful.Post mortem showed a fetal weight corresponding to 19 weeks of gestation, with a brain weight corresponding to 24-25 weeks (asymmetric growth restriction). The placenta weighed 412 g and showed massive subchorionic hematoma (Breus mole) involving the entire subchorionic space, with a thickness of up to 5 cm.Breus mole is a rare condition in pregnancy in which the chorionic plate is stripped from the villous chorion by a large amount of blood. Its etiology is unclear, although molecular techniques using polymerase chain reaction analysis have shown that the source of hematoma is maternal, and similar findings-in which 85% of clot DNA was of maternal origin-have been demonstrated with semi-quantitative Southern blot analysis [1].Breus mole has frequently been associated with spontaneous abortion, preterm delivery, intrauterine growth restriction [2], placental abruption [3], and intrauterine fetal death. An association between Breus mole and partial mole has also been reported [1].Prenatal diagnosis of Breus mole can be made using imaging techniques such as magnetic resonance imaging, which-together with ultrasound and pulse Doppler imaging-may help in the clinical management of the condition [4]. Histologic examination of the placenta and membranes further contributes to the diagnosis of Breus mole in the majority of cases.

Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus' mole)

“…Kojima Secondly, although the original description was in a nonviable pregnancy, 11 a combined survival rate of 50% (6/12 cases) is evident in a series of previous case reports. [12][13][14][15][16][17][18] Our relatively large single center experience demonstrating a 50% survival is consistent with the cumulative experience of the earlier reports. Although subject to ascertainment bias, our data demonstrate that survival is possible with this condition.…”

“…Most descriptions of the ultrasound appearances of Breus' mole, also referred to as massive subchorionic thrombohematoma (MTH), have been in case reports . In contrast with the original description in a nonviable pregnancy, a later report demonstrated that fetal survival may be possible with this condition .…”

“…Most descriptions of the ultrasound appearances of Breus' mole, also referred to as massive subchorionic thrombohematoma (MTH), have been in case reports. [12][13][14][15][16][17][18] In contrast with the original description in a nonviable pregnancy, a later report demonstrated that fetal survival may be possible with this condition. 19 Here, we describe a single center experience of consecutive 14 cases to explore the underlying disease pathogenesis and provide prognostic information that may be useful when counseling women with suspected MTH.…”

Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

“…29 A case report describing severe growth restriction and abnormal umbilical artery Doppler studies at 24 weeks' gestation in the setting of an SCH reported a placental abruption and fetal demise at 25 weeks' gestation. 34 In the meta-analysis by Tuuli et al, 6 SCH had an OR of 5.71 (CI, 3.91-8.33) for abruption.…”

“…33 Fetal growth restriction and absent end diastolic flow on umbilical artery Doppler studies at 24 6/7 weeks' gestation in the setting of a massive SCH have also been described. 34 In a series of massive SCHs, 10/17 patients had FGR, and 5 also had abnormal umbilical artery Doppler studies (absent or reversed end diastolic flow). 29 All 5 fetuses that had abnormal umbilical artery Doppler studies ended with a fetal demise.…”