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Case Report

Maternal floor infarction: A rare cause of suddenintrauterine fetal demise

Astha Agarwal a,*, Shanti Jeyaseelan b

aRegistrar, Indraprastha Apollo Hospitals, New Delhi, IndiabHead of Department, Holy Family Hospital, New Delhi, India

a r t i c l e i n f o

Article history:

Received 14 March 2013

Accepted 22 June 2013

Available online 6 July 2013

Keywords:

Maternal

Infarction

Placenta

IUFD

Labor

* Corresponding author.E-mail address: dr_astha_agarwal@yahoo

0976-0016/$ e see front matter Copyright ªhttp://dx.doi.org/10.1016/j.apme.2013.06.001

a b s t r a c t

Introduction: Maternal floor infarction is a rare placental lesion in which large amounts of

fibrin are deposited along the basal plate, which becomes avascular and sclerotic. The rate

of fetal salvage is very poor as the lesion develops rapidly.

Case report: Booked G3P1L1A1 at 39 weeks gestation with obstetric history of an uneventful

FTNVD followed by a first trimester MTP. In this pregnancy she had a normal antenatal

course with reactive NST in last 2 visits at 37 and 38 weeks respectively. Routine NST 8 h

prior to admission was reactive. She had no complaints. Patient was admitted for elective

IOL. NST reactive at the time of admission. Routine FHR monitoring by Doppler after 2 h of

admission just prior to induction of labor showed absent FHR. Urgent USG done, confirmed

sudden IUFD. Patient and her family counseled. IOL done. She had normal vaginal delivery

of fresh stillborn male baby. Liquor was normal. Baby had no gross congenital anomaly.

Placenta had yellowish discoloration of a remarkably smooth maternal surface. Histopa-

thology was compatible with maternal floor infarction.

Conclusion: Placental dysfunction in maternal floor infarction appears late in the process of

the disease and the lesion develops rapidly within hours. Recurrence rate is as high as 39%

in subsequent pregnancies. In all cases of IUFD placenta should be sent for histopatho-

logical examination to rule out this rare cause of sudden IUFD at term.

Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.

1. Introduction 2. Case report

Maternal floor infarction is a rare placental lesion (incidence

0.09%e5%)1 in which large amounts of fibrin are found

deposited along the basal plate, which becomes avascular and

sclerotic. The findings are often associated with fetal demise

or premature delivery. The rate of fetal salvage is very poor

and the lesion may recur in subsequent pregnancies (inci-

dence 39%).2

.co.in (A. Agarwal).2013, Indraprastha Medic

We report a case of booked 29 years old G3P1L1A1 who was

admitted for induction of labor at 39 weeks of gestation. Her

obstetric history was a full term normal vaginal delivery of a

healthy female baby at term 5 years back, followed by a first

trimester MTP for missed abortion.

In this pregnancy she had a normal antenatal course. All

the routine ultrasound were normal. Routine NST done for

al Corporation Ltd. All rights reserved.

a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 9 7e2 9 8298

fetal surveillance at 37 and 38 weeks were reactive with a

baseline fetal heart rate of 140 beats/min and variability of

8e10 beats/min. She was advised admission for IOL at 39

weeks. 8 h prior to admission NST done in OPD was also

reactive. Routine NST on admission was reactive. 2 h after

admission just prior to IOL routine fetal heart rate monitoring

was done with Doppler. The fetal heart sound could not be

localized and hence an urgent USG was done.

Urgent USG confirmed sudden intrauterine fetal demise.

Patient and her family were counseled. IOL done with cervi-

prime gel and the patient delivered fresh stillborn male baby

weighing 3.010 kg. Liquor was clear and not foul smelling.

Baby had no gross congenital anomaly. Placenta appeared to

be abnormal on gross examination. There was yellowish

discoloration of a remarkably smooth maternal surface.

Placenta was sent for histopathological examination. His-

tology was compatible with maternal floor infarction of the

placenta.

3. Conclusion

Maternal floor infarction is a rare placental lesion of unknown

etiology and is often associated with sudden intrauterine fetal

demise and intrauterine growth restriction. Placental

dysfunction appears late in the process of the disease and the

lesion develops rapidly within hours. In all cases of sudden

IUFD the obstetrician should sent the placenta for histopath-

ological examination to rule out this rare cause of sudden

IUFD.

4. Discussion

Maternal floor infarction of the placenta is a relatively rare

disorder that leads to sudden IUFD2 (incidence: 40%) and IUGR.

Thepathophysiologyofthe lesionremainsunclear.Maternal

floor infarction frequently recurs in successive pregnancies

(rate 39%)2 and there is evidence that it develops rapidly.3

It is a disorder, characterized by heavy deposition of fibrin

in the region of the basal villi immediately adjacent to the

decidua basalis. The fibrin extends into the intervillous space

where it envelops the basal villi, which becomes avascular

and sclerotic. It is not an infarct and is most directly distin-

guished from a placental infarct by the fact that, the affected

villi are widely separated by fibrin; whereas in infarcts the villi

are typically crowded together. Grossly, the maternal surface

of the placenta is thickened; firmand yellow.1 Given the risk of

recurrence to be as high as 39%, the identification of maternal

floor infarction (by either a history of sudden IUFD of un-

known etiology at term or a confirmed report of maternal floor

infarction in previous pregnancy) should alert the clinician to

the potential for growth retardation, preterm birth and sud-

den intrauterine fetal demise at term in subsequent preg-

nancies. Hence delivery should be considered when

pulmonary maturity has been established.2

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Blaustein’s Pathology of the Female Genital Tract. 5th ed. 1135.2. Andres Robert L, Kryper William, Resnik Robert. The

association of maternal floor infarction of the placenta withadverse perinatal outcome. Am J Obstet Gynecol. July1990;163:935e958.

3. Clewell William H, Manchester David K. Recurrent maternalfloor infarction e a preventive cause of fetal death. Am J ObstetGynecol. Sept 1983;1:346.

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