title: Discordancy for Placental Massive Perivillous Fibrin Deposition and Fetal Growth in Dichorionic Twins after In Vitro Fertilization.
abstract: Massive perivillous fibrin deposition (MFD) is a placental lesion of unknown etiology associated with perinatal morbidity and mortality and recurrence risk in subsequent pregnancies. We report a 34 weeks' gestation dizygotic twin pregnancy with discordancy for MFD and for intrauterine growth restriction after in vitro fertilization (IVF). Only the smaller twin corresponding to the placenta affected by MFD showed intrauterine growth restriction, with a weight below the 3rd percentile according to gestational age. The affected placenta showed a moderate increase in decidual lymphocytes. No difference in expression of complement factor C4d in umbilical veins could be observed. Development of MFD in one of the dizygotic placentas may be due to a pathologic immune response to one of the different fetal genotypes as semiallografts. The pathogenetic role of IVF as an environmental factor for development of MFD is unclear.
authors.affiliation: 1 Department of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Feist
authors.affiliation: 2 Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany.
authors.forename: Thordis
authors.initials: T
authors.lastname: Blöcker
authors.affiliation: 3 Department of Pediatrics and Perinatal Medicine, Diakonissenkrankenhaus Flensburg, Flensburg, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Rau
authors.affiliation: 4 Department of Pathology, Medical School, Hannover, Germany.
authors.forename: Kais
authors.initials: K
authors.lastname: Hussein
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000209:etiology*; D006801:Humans; D007150:Immunohistochemistry; D010922:Placenta Diseases / Q000473:pathology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D014429:Twins, Dizygotic
keywords: discordant twin growth; in vitro fertilization; massive perivillous fibrin deposition; placental pathology