title: Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome.
abstract: OBJECTIVE
  To describe the sonographic features and pregnancy outcomes of placental mesenchymal dysplasia (PMD), an entity often misdiagnosed as molar pregnancy.
  
  
  METHODS
  We reviewed PMD cases from our institution and performed a systematic review of the existing literature. Inclusion criteria for the review were diagnosis of PMD as defined by placental pathology, description of placental morphology on antenatal ultrasound and reporting of pregnancy outcomes.
  
  
  RESULTS
  We found three cases of PMD at our institution. Patient 1 had elevated human chorionic gonadotropin (hCG) and an enlarged, hydropic placenta at 13 weeks, suggestive of a molar pregnancy. Patient 2 also had elevated hCG with large, vascular placental lakes on ultrasound suggesting placenta accreta or molar pregnancy. Case 3 involved placentomegaly and fetal anomalies suggestive of Beckwith-Wiedemann syndrome. From the literature review, 61 cases met the inclusion criteria. The most common sonographic features included enlarged (50%) and cystic (80%) placenta with dilated chorionic vessels. Biochemical aneuploidy screening abnormalities were relatively common as were fetal anomalies, Beckwith-Wiedemann syndrome and other genetic abnormalities. Pregnancy complications included intrauterine growth restriction (IUGR; 33%), intrauterine fetal death (IUFD; 13%), and preterm labor (33%). Pregnancies without fetal anomalies, IUGR, IUFD or preterm labor had normal neonatal outcomes despite PMD (9%).
  
  
  CONCLUSIONS
  The differential diagnosis of PMD includes molar pregnancy and other placental vascular anomalies. PMD is associated with adverse pregnancy outcome, so heightened surveillance with genetic evaluation, serial growth scans and third-trimester assessment of wellbeing should be considered. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ.
authors.affiliation: Department of Obstetrics and Gynecology, SUNY Upstate Medical University, Syracuse, NY 13202, USA. unzilanayeri@gmail.com
authors.forename: U A
authors.initials: UA
authors.lastname: Nayeri
authors.forename: A B
authors.initials: AB
authors.lastname: West
authors.forename: H K
authors.initials: HK
authors.lastname: Grossetta Nardini
authors.forename: J A
authors.initials: JA
authors.lastname: Copel
authors.forename: A K
authors.initials: AK
authors.lastname: Sfakianaki
mesh_terms: D001506:Beckwith-Wiedemann Syndrome / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging* / Q000473:pathology; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D006828:Hydatidiform Mole / Q000000981:diagnostic imaging* / Q000473:pathology; D007231:Infant, Newborn; D010920:Placenta / Q000000981:diagnostic imaging / Q000473:pathology*; D010922:Placenta Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D011247:Pregnancy; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*