Decidual Vasculopathy: Placental Location and Association with Ischemic Lesions

Abstract

Decidual vasculopathy (DV) is a general term for a number of lesions involving uteroplacental vessels. It is often seen in preeclamptic placentas and indicates a disorder of uteroplacental malperfusion and is associated with placental ischemia and infarction. Although some have advocated submitting special sections in order to better document DV, it is unclear which placental sections have the highest yield in demonstrating these abnormal vessels. 76 consecutive cases of decidual vasculopathy were identified and evaluated for location of DV, as well as presence of other lesions of ischemic change, infarcts and retroplacental hematomas. Sections reviewed were the membrane roll, full thickness sections of the placental disc, and sections specifically of the basal plate. DV was found in the membrane roll (MR) in 67.1% of cases, in full thickness sections (FT) in 32.9% and in the basal plate (BP) in 25.0% of cases (p value = 0.004). DV was exclusive to the MR in 53.9%, the FT in 14.5% and the BP in 9.2%. DV was present in 2 locations in 19.7% and in all 3 locations in 2.6%. The presence of DV in any location (MR, FT, BP) was associated with placental ischemic change but not specifically with infarcts or retroplacental hematomas. The specific location of DV showed no difference in the presence of placental lesions. Our findings indicate DV is often present in one location, and is associated with lesions of malperfusion. It is recommended that when clinically indicated, additional sections are submitted to demonstrate decidual vasculopathy.