OP13.11: Placental mesenchymal dysplasia: four cases

Abstract

We report prenatal diagnosis of four cases with placental mesenchymal dysplasia (PMD) and review of literature. Case 1: Primigravida of 15 weeks was referred for abnormal-appearing cystic placenta on ultrasound scanning, with hypoechoic areas. Normal fetal Doppler, and abnormal maternal Doppler. We diagnosed PMD and indicated treatment with heparin and aspirin. During third trimester intrauterine growth restriction (IUGR) was found. Caesarean section was performed at 38 w, new born was IUGR fetus. Placental pathology showed PMD. Case 2: Multiparous was sent because abnormal placental cyst. Normal fetal Doppler, abnormal maternal Doppler. PMD was diagnosed, heparin and aspirin were indicated. At 24 w, fetal mesenchymal tumours were found in liver, suprarenal and abdomen, showing an accelerated growth, with normal fetal Doppler. A decrease in fetal movements was objectified at 28 w. and finally at 29 w, fetal was death. Placental pathology showed PMD. Case 3: Primigravida of 21 w. referred with diagnosis of IUGR and partial mole. Fetus had absent diastolic flow in umbilical artery, abnormal maternal Doppler, normal ACM, multiple cystic images in placenta and HCG-B within normal values. With this findings, PMD was diagnosed. She started treatment with heparin and aspirin. At 34 w, pregnancy had to be finished due rupture of membranes, obtaining an IUGR fetus. Placental pathology showed PMD. Case 4: Patient of 23 weeks of pregnancy, obese, with normal fetus, placenta with multiple cystic images and abnormal maternal Doppler, aspirin was started. At 29 w. she presented headache, proteinuria, high blood pressure, and death. Placental pathology showed PMD. Conclusion: PMD is a rare placental disease. There are multiple theories, but the exact etiology of PMD is unclear. PMD is frequently misdiagnosis and have poor pregnancy outcome. Diagnosis should be considered with specific sonographic findings, including enlarged, cystic placenta with dilated chorionic vessels.