Ringed Placenta: Changes in Placental Perfusion Associated with Increased Mortality with Ventral Body Wall Defect [18E

Abstract

INTRODUCTION: Purpose is to assess perinatal morbidity/mortality among infants with ventral wall defects (VWD) and abnormal placental perfusion patterns on prenatal MRI. METHODS: A retrospective case series of pregnancies complicated by VWD (omphalocele, OEIS sequence, and bladder exstrophy) performed over a 7-year period. Maternal and infant charts were reviewed for basic demographic data, placental pathology, and neonatal outcomes. MRI studies were reviewed by 2 experts with a specialized focus in fetal MRI. RESULTS: 31 cases of VWD were noted, and 11 cases possessed a novel placental perfusion pattern of a “ringed placenta” (pattern of rings of hyperintense MR signal surrounding hypointense placental cotyledons) seen throughout the parenchyma. In cases with a ringed placenta, five of 11 (45%) survived until 6 months of age. For the control group of VWD without the ringed placenta fourteen of 20 (70%) survived until 6 months of age. The relative risk for stillbirth/neonatal demise vs stillbirth/demise within 24hrs was 1.32 vs. 2.3 in VWD with the ringed placenta. Over 50% of infant demises with abnormal placental findings and 25% of normal placenta finding were found to be small for gestational age (SGA) at birth, while all of the surviving infants were within normal range birth weight for gestational age. CONCLUSION: Compared to those pregnancies without the “ringed placenta, cases of VWD with the ringed placenta had a higher rate of death and were more likely to be SGA at birth. We did not find an increased risk of extremely low birth weights. Further study is needed to characterize this finding.