title: Fetal thrombotic vasculopathy is associated with thromboembolic events and adverse perinatal outcome but not with neurologic complications: a retrospective cohort study of 54 cases with a 3-year follow-up of children.
abstract: OBJECTIVE
  to test the hypothesis that placental fetal thrombotic vasculopathy (FTV) is associated with obstetric complications and predisposes the child to unfavorable outcomes.
  
  
  METHODS
  54 placentas with FTV lesions and 100 placentas without FTV lesions were collected over a 5-year period at the Croix-Rousse Pathology Department. Clinical findings including maternal, fetal, neonatal condition and pediatric outcome up to three years were collected for each case and control observation. The statistical analyses were assessed with Wald's chi-square derived from conditional logistic regression modeling.
  
  
  RESULTS
  FTV was associated with a significantly higher frequency of obstetric complications: (pregnancy-induced hypertension (OR 3.620, CI 1.563-8.385), preeclampsia (OR 3.674, CI 1.500-8.998), emergency delivery procedures (OR 3.727, CI 1.477-9.403), cesarean sections (OR 2.684, CI 1.016-7.088)), poor fetal condition (intrauterine growth restriction (IUGR) (OR 5.440, CI 2.007-14.748), nonreassuring fetal heart tracing (OR 6.062, CI 2.280-16.115), difficulties in immediate ex utero adaptation (OR 3.416, CI 1.087-10.732)) and perinatal or early childhood demise (OR 3.043, CI 1.327-6.978). On pathological examination, FTV was associated with marginal cord insertion (OR 3.492, CI 1.350-9.035), cord stricture and hypercoiled cord (OR 3.936, CI 1.209-12.813). Thromboembolic events were significantly more frequent in cases with FTV (OR 2.154, CI 1.032-5.622). Neurological complications within the first 3 years of life were also more frequent in the FTV group compared to the control group, but this association was not statistically significant.
  
  
  CONCLUSIONS
  FTV is associated with maternal complications, pathological findings in the placenta, especially gross cord abnormalities, IUGR, and poor perinatal or early childhood outcome. It may also predispose children to somatic thromboembolic events.
authors.affiliation: Centre de Pathologique Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: L
authors.initials: L
authors.lastname: Lepais
authors.affiliation: Centre de Pathologique Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: L
authors.initials: L
authors.lastname: Gaillot-Durand
authors.affiliation: Service de Biostatistique, Hospices Civils de Lyon, F-69003 Lyon, France; CNRS, UMR5558, F-69100 Villeurbanne, France.
authors.forename: F
authors.initials: F
authors.lastname: Boutitie
authors.affiliation: Centre de Pathologique Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: F
authors.initials: F
authors.lastname: Lebreton
authors.affiliation: Service de Réanimation Néonatale, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: R
authors.initials: R
authors.lastname: Buffin
authors.affiliation: Service d'Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: C
authors.initials: C
authors.lastname: Huissoud
authors.affiliation: Service d'Obstétrique, Hôpital Femme-Mère-Enfant, 59 Boulevard Pinel, 69677 Bron Cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Massardier
authors.affiliation: Service d'Imagerie Pédiatrique et Fœtale, Hôpital Femme-Mère-Enfant, 59 Boulevard Pinel, 69677 Bron Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Guibaud
authors.affiliation: Centre de Pathologique Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
authors.forename: M
authors.initials: M
authors.lastname: Devouassoux-Shisheboran
authors.affiliation: Centre de Pathologique Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France. Electronic address: fabienne.allias@chu-lyon.fr.
authors.forename: F
authors.initials: F
authors.lastname: Allias
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology / Q000473:pathology; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D015995:Prevalence; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult
keywords: Avascular villi; Fetal thrombotic vasculopathy; Intrauterine growth restriction; Neurologic disorders; Perinatal outcome; Thromboembolic events