Placental mesenchymal dysplasia associated with antepartum hemorrhage, subchorionic hematoma and intrauterine growth restriction

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Title:	Placental mesenchymal dysplasia associated with antepartum hemorrhage, subchorionic hematoma and intrauterine growth restriction
Authors:	陳持平;Chen, Chih-Ping;Hs, Chin-Yuan;Hsu, Chin-Yuan;Su, Yi-Ning;Su, Yi-Ning;Wa, Tao-Yeuan;Wang, Tao-Yeuan;Chen, Yi-Yung;Chen, Yi-Yung;Ch, Schu-Rern;Chern, Schu-Rern;Su, Jun-Wei;Su, Jun-Wei;Wang, Wayseen;Wang, Wayseen
Contributors:	生物科技學系
Date:	2013-03
Issue Date:	2013-07-11 05:55:25 (UTC+0)
Abstract:	A primigravid woman 38 years of age underwent amniocentesis at 17 weeks of gestation because of advanced maternal age, and the result revealed a karyotype of 46,XY. She was admitted to the hospital at 17 weeks of gestation because of antepartum hemorrhage, placenta previa, subchorionic hematoma, premature uterine contractions, and premature rupture of the membranes following amniocentesis. Level II ultrasonography revealed an amniotic fluid index of 6 cm, a singleton fetus with a biparietal diameter (BPD) of 3.35 cm (15.8 weeks), an abdominal circumference (AC) of 10.4 cm (16.3 weeks), a femur length (FL) of 1.63 cm (14.8 weeks), subchorionic hematoma, and a suspicion of placental abruption. At 20 weeks of gestation, the fetal biometry was equivalent to 18 weeks of gestation with a BPD of 4.5 cm (19.1 weeks), an AC of 12 cm (18 weeks), an FL of 2.28 cm (17.2 weeks), and an enlarged placenta with multiple hypoechoic spaces (Fig. 1). A diagnosis of placental mesenchymal dysplasia (PMD) was made. Chorionic villus sampling (CVS) of the bulky placenta was performed. Molecular analysis of the sampled placental tissue revealed no uniparental disomy (UPD) 11 and no genomic imbalance. The karyotype of CVS was 46,XY. Repeated amniocentesis revealed coffee-like brownish colored amniotic fluid. The karyotype of amniocentesis was 46,XY. Array comparative genomic hybridization (aCGH) analysis revealed no genomic imbalance in the amniocytes. At 22 weeks of gestation, the multiple hypoechoic spaces in the placenta persisted and intrauterine growth restriction (IUGR) was evident, and the fetal biometry was equivalent to 18 weeks of gestation. At 23 weeks of gestation, a dead 288-g male fetus was delivered with a bulky placenta weighing 300 g. The fetus was apparently normal. Gross examination of the maternal surface of the placenta showed multiple grape-like and dilated and tortuous subchorionic vessels (Fig. 2). Microscopic examination showed large dilated villi with the presence of obliterated vasculature, thrombosis, and hemorrhage, and the absence of trophoblastic proliferation (Fig. 3). Postnatal genetic analysis of the dilated villi showed no methylation abnormality, a karyotype of 46,XY, and biparental inheritance with a 1:1 paternal:maternal dosage ratio in the microsatellite analysis of chromosomes 6, 7, 11, and 15.
Relation:	Taiwanese Journal of Obstetrics & Gynecology,52(1),154–156.
Appears in Collections:	[Department of Biotechnology] Journal Article

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