Clinicopathological characteristics of miscarriages featuring placental massive perivillous fibrin deposition. (October 2019)

• Record Type: Journal Article
• Authors: Kim, Eun Na; Lee, Joong Yeup; Shim, Jae-Yoon; Hwang, Doyeong; Kim, Ki Chul; Kim, So Ra; Kim, Chong Jai
• Is Part Of: Placenta. Volume 86(2019)
• Page Start: 45
• Page End: 51
• Publication Date: 2019-10
• Subjects: Placenta -- Recurrent miscarriage -- Massive perivillous fibrin deposition -- C4d -- HLA; Placenta -- Periodicals; Reproduction -- Periodicals; Placenta -- Periodicals; Placenta -- Périodiques; Reproduction -- Périodiques; 612.63
• DOI: 10.1016/j.placenta.2019.07.006
• Languages: English
• ISSNs: 0143-4004

Abstract

Abstract: Introduction: Massive perivillous fibrin deposition (MPFD) is frequently associated with detrimental pregnancy outcomes, and extensive perivillous fibrin deposition results in severe placental dysfunction and loss of maternofetal interface. Unfortunately, the fundamental pathogenesis of MPFD remains unknown, and systematic analyses of MPFD in miscarriage is lacking. We analyzed the frequency and clinicopathological characteristics of MPFD in first trimester miscarriages. Methods: We analyzed a consecutive series of miscarriages (n = 582) gathered between March 2012 and June 2016. MPFD was classified as fibrin-type (f-MPFD) and matrix-type (m-MPFD) by immunostaining for fibrin and collagen type IV. The control group consisted of miscarriage cases (MC, n = 18) that were matched to f-MPFD with normal chromosome (f-MPFD-nc) for number of previous miscarriages and placental chromosomal status. Results: MPFD was identified in 2.7% of miscarriages. f-MPFD was associated with recurrent abortions. Compared with miscarriages without fibrin deposition, MPFD cases had higher proportion of those with normal placental chromosome (69.2% vs. 27.4%, P < 0.005) and higher frequency of villous syncytiotrophoblast C4d deposition (73.3% vs. 33.9%, P < 0.005). All C4d(+) f-MPFD patients had more than three recurrent miscarriages, whereas C4d(−) f-MPFD patients had no history of recurrent miscarriage (P < 0.05). Patients with f-MPFD-nc had significantly higher HLA PRA immunopositivity rate than did MC patients (P = 0.005). Discussion: MPFD was more common in miscarriages than in preterm and term pregnancies. Placental massive fibrin-type fibrinoid deposition and villous C4d immunoreactivity were associated with recurrent miscarriage. Highlights: MPFD more common in miscarriage than preterm, term deliveries. Fibrin/collagen type IV immunostaining; a tool for subtyping of fibrinoid in MPFD. Placental C4d staining characterizes the pathology of MPFD in miscarriage. Fibrin-type MPFD and villous C4d positivity; associated with recurrent miscarriages.