EP16.53: Placental infarct: clinical, ultrasonographic and histopathological correlation

We present the case of a 38 year-old patient who attended the emergency room at 30+4 weeks, with a 1 week history of headache, phosphenes, and bilateral lower limb edema. Physical examination was normal, but her blood pressure was 150/100 mmHg. The 2D ultrasound examination reported fetal growth restriction, oligohydramnios, and five anechoic non-vascularised images within the placenta, the largest being 26x25x28mm, surrounded by an echogenic halo. Additional exams reported isolated proteinuria of 767mg and creatinine of 1.02 mg/dL. She received management with a bolus of labetalol, followed by oral nifedipine, magnesium sulphate and pulmonary maturation with betamethasone. Due to the high risk of maternal deterioration, placenta abruption and stillbirth, it was considered that she did not meet expectancy criteria and was taken to emergency Caesarean section. The surgery was carried out without complications with a live male newborn, of 2.601 pounds and 14.96 inches. Gross anatomy of the placenta evidenced 5 avascular, hollow areas, suggestive of necrosis. Histopathology reported multiple infarcts in different stages in the corial plate; these morphological findings indicate inadequate vascular perfusion of the mother, a pattern described in pre-eclampsia. Doppler techniques are very useful for the evaluation of intraplacental circulation and can be a great tool for diagnosis in placental anomalies. Placental infarcts are described as hyperechoic or echolucent avascular areas within the placenta. This is usually found in 40-70% of pregnancies with severe pre-eclampsia. Hyperechoic placental cystic lesions had 37% sensitivity for confirmed villous infarcts and a high-positive predictive value for fetal death when combined with abnormal Doppler velocimetry. We describe the correlation between clinical, ultrasonography, macroscopic (intraoperative finding) and histopathology in a patient with severe pre-eclampsia and placental infarcts.