Fetal thrombotic vasculopathy in the placenta: a thrombophilic connection between pregnancy complications and neonatal thrombosis?
OBJECTIVE
Fetal thrombotic vasculopathy (FTV) has been related to pregnancy complications and neonatal thrombosis separately. We assessed whether a relationship existed in our population of women with neonates who were admitted to our Neonatal Intensive Care Unit (NICU). In addition, the presence of thrombophilic factors in children and parents was investigated.


METHODS
Two groups were detected by a search of the departmental databases. Group A was a cohort of 5000 neonates admitted to our NICU (1992-2002). Infants who developed thrombotic complications were selected. Group B was a cohort of placentae from our institution (2000, n = 141). Those with a diagnosis of FTV were selected. Case-notes and laboratory results were obtained through the hospital information system.


RESULTS
Of Group A, thrombosis was reported in 55 children. Of these, 20 matching placentae were available. Eight placentae showed FTV (40 per cent). Of the eight corresponding pregnancies, seven were complicated by pre-eclampsia and/or intra uterine growth restriction (IUGR). Of the 12 placentae without FTV, five of the pregnancies had pre-eclampsia and/or IUGR (odds ratio for relation FTV-Complications: 9.8, 95 per cent CI = 0.9-107). In Group B, nine placentae showed FTV (6.4 per cent). Of these nine, six of the pregnancies were complicated by pre-eclampsia and/or IUGR. None of the neonates developed thrombosis.


CONCLUSIONS
Pre-eclampsia and/or IUGR as well as neonatal thrombosis are both associated with fetal thrombotic vasculopathy in the placenta. However, in our selected-tertiary centre-population, FTV did not predict neonatal thrombosis. The thrombophilic investigations of parents and children were incomplete. A standard approach for evaluating parents at risk for FTV and evaluating neonates at risk for thrombosis should be developed.
Leistra-Leistra
M J
MJ
Department of Obstetrics and Gynaecology, University Hospital Groningen, P.O. Box 30.001, 9700 Groningen, The Netherlands.
Timmer
A
A
van Spronsen
F J
FJ
Geven
W B
WB
van der Meer
J
J
Erwich
J J H M
JJ
D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000473:pathology*; D010920:Placenta / Q000098:blood supply; D010922:Placenta Diseases / Q000150:complications / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D019851:Thrombophilia / Q000150:complications / Q000473:pathology*; D013927:Thrombosis / Q000209:etiology / Q000473:pathology*