title: Maternal floor infarction/massive perivillous fibrin deposition: a manifestation of maternal antifetal rejection?
abstract: OBJECTIVE
  Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) are related placental lesions often associated with fetal death and fetal growth restriction. A tendency to recur in subsequent pregnancies has been reported. This study was conducted to determine whether this complication of pregnancy could reflect maternal antifetal rejection.
  
  
  METHODS
  Pregnancies with MPFD were identified (n = 10). Controls consisted of women with uncomplicated pregnancies who delivered at term without MPFD (n = 175). Second-trimester maternal plasma was analyzed for panel-reactive anti-HLA class I and class II antibodies. The prevalence of chronic chorioamnionitis, villitis of unknown etiology, and plasma cell deciduitis was compared between cases and controls. Immunohistochemistry was performed on available umbilical vein segments from cases with MPFD (n = 4) to determine whether there was evidence of complement activation (C4d deposition). Specific maternal HLA-antibody and fetal HLA-antigen status were also determined in paired specimens (n = 6). Plasma CXCL-10 concentrations were measured in longitudinal samples of cases (n = 28 specimens) and controls (n = 749 specimens) by ELISA. Linear mixed-effects models were used to test for differences in plasma CXCL-10 concentration.
  
  
  RESULTS
  (i) The prevalence of plasma cell deciduitis in the placenta was significantly higher in cases with MPFD than in those with uncomplicated term deliveries (40% versus 8.6%, P = 0.01), (ii) patients with MPFD had a significantly higher frequency of maternal anti-HLA class I positivity during the second trimester than those with uncomplicated term deliveries (80% versus 36%, P = 0.01); (iii) strongly positive C4d deposition was observed on umbilical vein endothelium in cases of MPFD, (iv) a specific maternal antibody against fetal HLA antigen class I or II was identified in all cases of MPFD; and 5) the mean maternal plasma concentration of CXCL-10 was higher in patients with evidence of MPFD than in those without evidence of MFPD (P < 0.001).
  
  
  CONCLUSIONS
  A subset of patients with MPFD has evidence of maternal antifetal rejection.
authors.affiliation: Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, Bethesda, MD, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Amy
authors.initials: A
authors.lastname: Whitten
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Korzeniewski
authors.forename: Nandor Gabor
authors.initials: NG
authors.lastname: Than
authors.forename: Piya
authors.initials: P
authors.lastname: Chaemsaithong
authors.forename: Jezid
authors.initials: J
authors.lastname: Miranda
authors.forename: Zhong
authors.initials: Z
authors.lastname: Dong
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
mesh_terms: D000328:Adult; D054360:Chemokine CXCL1 / Q000097:blood; D002824:Chorionic Villi / Q000378:metabolism* / Q000473:pathology; D003181:Complement C4 / Q000378:metabolism; D004730:Endothelium, Vascular / Q000276:immunology / Q000378:metabolism; D005260:Female; D005313:Fetal Death / Q000209:etiology / Q000276:immunology*; D005317:Fetal Growth Retardation / Q000209:etiology / Q000276:immunology*; D005337:Fibrin / Q000378:metabolism*; D006680:HLA Antigens / Q000276:immunology; D054502:Histocompatibility, Maternal-Fetal; D006801:Humans; D007238:Infarction / Q000150:complications / Q000276:immunology*; D007518:Isoantibodies / Q000097:blood; D017773:Pelvic Floor / Q000098:blood supply / Q000473:pathology*; D010920:Placenta / Q000276:immunology*; D011247:Pregnancy; D055815:Young Adult
chemical_list: D054360:Chemokine CXCL1; D003181:Complement C4; D006680:HLA Antigens; D007518:Isoantibodies; D005337:Fibrin
keywords: CXCL; Fibrinoid deposition; HLA; MFI; MPFD; PRA; VUE; chorioamnionitis; plasma cell deciduitis; pregnancy; stillbirth; villitis
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