Maternal floor infarction: A rare cause of sudden intrauterine fetal demise

Abstract

IntroductionMaternal 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 reportBooked 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. Histopathology was compatible with maternal floor infarction. ConclusionPlacental 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 histopathological examination to rule out this rare cause of sudden IUFD at term.