Recurrent Placental Microcalcifications in the Second Trimester

Abstract

Placental problems are uncommon during pregnancy. Benign pathologic findings of the placenta include placenta previa or abruption, velamentous cord insertion, succenturiate lobe, circumvallate placenta, battledore placenta, placentomegaly, and chorioangioma. We present the case of a mother who experienced recurrent placental microcalcifications in the early second trimester, with associated intrauterine growth retardation (IUGR). A 27-year-old woman, gravida 2, para 1, presented at 24 weeks of gestation. She had received prenatal care in our department since early pregnancy. The prenatal ultrasound examination performed before 24 weeks of gestation was uneventful, but progressive microcalcifications of the placenta were noted subsequently. The entire placenta was covered with small calcified spots. Her past gynecologic and obstetric history was notable for having been a very low birth weight baby (1,450 g, delivered at 29 weeks preterm), and for having had a very low body mass index of 16–18 kg/m 2 since childhood. Her general condition was normal, except for frequent common colds. At the time of her second pregnancy, her body weight was 38 kg and her height was 150 cm. Her body mass index was 17 kg/m 2 (normal, 22–25 kg/m 2 ). Her first pregnancy had occurred 2 years earlier and severe placental microcalcifications had developed, along with IUGR by 27 weeks of gestation. Her baby was delivered at term by cesarean section because of breech presentation. The baby weighed 2,450 g. The histopathologic findings of the placenta were unremarkable except for grade III chorioamnionitis. Placental microcalcifications developed earlier during her current pregnancy, at 24 weeks of gestation. The snow-like small calcified spots were scattered around the entire placenta (Figures A–C), but did not occur on the fetal parts of the placenta. Symmetric IUGR was noted at 32 weeks of gestation, earlier than in her last pregnancy. Steroid supplementation (betamethasone 12 mg intramuscularly every 24 hours for 2 doses) was given for lung maturation. The screening results for toxoplasmosis, other congenital syphilis and viruses, rubella, cytomegalovirus, and herpes simplex virus were unremarkable and she had no intrauterine infection, as with her previous pregnancy. She underwent cesarean delivery at 36 weeks of gestation because of severe IUGR, with an estimated fetal weight of 2,200 g. A healthy baby was delivered, with no obvious perinatal problems. Placental calcium deposition is a normal physiologic process that occurs throughout pregnancy. During the first 6 months, the microcalcification is microscopic;