Intrauterine Growth Restriction Associated with Hematologic Abnormalities: Probable Manifestations of Placental Mesenchymal Dysplasia

Abstract

Introduction Placental mesenchymal dysplasia is a rare vascular disease associated with intrauterine growth restriction, fetal demise as well as Beckwith–Wiedemann syndrome. Some neonates present hematologic abnormalities possibly related to consumptive coagulopathy and hemolytic anemia in the placental circulation.

Case report We present a case of placental mesenchymal dysplasia in a fetus with intrauterine growth restriction and cerebellar hemorrhagic injury diagnosed in the 20th week of pregnancy. During 26th week, our patient had an intrauterine fetal demise in the context of gestational hypertension. We have detailed the ultrasound findings that made us suspect the presence of hematologic disorders during 20th week.

Discussion We believe that the cerebellar hematoma could be the consequence of thrombocytopenia accompanied by anemia. If hemorrhagic damage during fetal life is found, above all associates with an anomalous placental appearance and with intrauterine growth restriction, PMD should be suspected along other etiologies.

Keywords

placental abnormalities - placentomegaly - placental vascular abnormality - hematologic disorders - intrauterine growth restriction

• References

• 1 Moscoso G, Jauniaux E, Hustin J. Placental vascular anomaly with diffuse mesenchymal stem villous hyperplasia. A new clinico-pathological entity?. Pathol Res Pract 1991; 187 (2-3) 324-328
• 2 Nayeri UA, West AB, Grossetta Nardini HK, Copel JA, Sfakianaki AK. Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome. Ultrasound Obstet Gynecol 2013; 41 (4) 366-374
• 3 Pham T, Steele J, Stayboldt C, Chan L, Benirschke K. Placental mesenchymal dysplasia is associated with high rates of intrauterine growth restriction and fetal demise: A report of 11 new cases and a review of the literature. Am J Clin Pathol 2006; 126 (1) 67-78
• 4 Sengers FB, van Lijnschoten G, van der Sluijs-Bens JP, Porath MM, Dijkman KP. Haematological abnormalities in premature babies due to placental mesenchymal dysplasia [in Dutch]. Ned Tijdschr Geneeskd 2010; 154: A1040
• 5 Koga H, Makimura M, Tanaka H, Sumioki H. Placental mesenchymal dysplasia and fetal hematologic disorder. J Pediatr Hematol Oncol 2014; 36 (6) e389-e391
• 6 Robertson M, Geerts LT, de Jong G, Wainwright H. Mesenchymal dysplasia in a monochorionic diamniotic twin pregnancy with review of the differential diagnosis of cystic changes in the placenta. J Ultrasound Med 2007; 26 (5) 689-693
• 7 Kaiser-Rogers KA, McFadden DE, Livasy CA , et al. Androgenetic/biparental mosaicism causes placental mesenchymal dysplasia. J Med Genet 2006; 43 (2) 187-192
• 8 Kapur RP, Cole B, Zhang M, Lin J, Fligner CL. Placental mesenchymal dysplasia and fetal renal-hepatic-pancreatic dysplasia: androgenetic-biparental mosaicism and pathogenesis of an autosomal recessive disorder. Pediatr Dev Pathol 2013; 16 (3) 191-200
• 9 Robinson WP, Lauzon JL, Innes AM, Lim K, Arsovska S, McFadden DE. Origin and outcome of pregnancies affected by androgenetic/biparental chimerism. Hum Reprod 2007; 22 (4) 1114-1122
• 10 Armes JE, McGown I, Williams M , et al. The placenta in Beckwith-Wiedemann syndrome: genotype-phenotype associations, excessive extravillous trophoblast and placental mesenchymal dysplasia. Pathology 2012; 44 (6) 519-527
• 11 Paradinas FJ, Sebire NJ, Fisher RA , et al. Pseudo-partial moles: placental stem vessel hydrops and the association with Beckwith-Wiedemann syndrome and complete moles. Histopathology 2001; 39 (5) 447-454
• 12 Maher ER, Reik W. Beckwith-Wiedemann syndrome: imprinting in clusters revisited. J Clin Invest 2000; 105 (3) 247-252