Massive perivillous fibrinoid causing recurrent placental failure

OBJECTIVE: To establish the incidence, recurrence rate and consequences of massive perivillous fibrinoid. DESIGN: Retrospective analysis of the histology of all placentas with a diagnosis of massive perivillous fibrinoid between 1991 and 1998, together with the maternal case records. SETTING: The histopathology department of the Rotunda Hospital, Dublin, Ireland. POPULATION: A relatively homogeneous group of pregnant women in the northern part of Dublin City, which is the catchment area for the Rotunda Hospital, delivered between 1991 and 1998. METHODS: Retrospective review of archival placental pathology and maternal charts. MAIN OUTCOME MEASURES: The incidence of massive perivillous fibrinoid, perinatal outcome and recurrence rate. RESULTS: The incidence of massive perivillous fibrinoid was 0.028%, with a recurrence rate of approximately 18%. All the infants suffered intrauterine growth restriction; there was a 31% fetal loss rate and a 33% preterm delivery rate. CONCLUSIONS: Massive perivillous fibrinoid is associated with intrauterine death, intrauterine growth restriction and preterm delivery. It has a significant recurrence rate and both the clinical findings of intrauterine growth restriction and the postmortem findings imply a syndrome of chronic placental insufficiency.