Ultrasound findings in pregnancies affected by placental perivillous fibrin deposition: A case series

Introduction: This article presents unique ultrasound findings in patients with perivillous fibrin deposition on placental pathology. Massive perivillous fibrin deposition (MPVFD), characterized by excessive deposition of fibrinoid material in the placenta, is a rare finding on pathologic investigation and has been associated with gestational morbidity and mortality. Case Series: We present three cases with abnormal prenatal ultrasound findings that were formally diagnosed with excessive perivillous fibrin deposition by postnatal pathologic specimen review. Cases 1 and 2 are of the same patient following subsequent pregnancies. The first pregnancy resulted in new fetal growth restriction, necessitating delivery at 34 weeks. The second pregnancy then warranted close sonographic monitoring. This pregnancy was overall uncomplicated until placental cysts appeared at 31 weeks. She had antenatal testing until her planned delivery at 37 weeks. Placental abnormality was noted at 24 weeks in the third case. She ultimately was delivered at 35 weeks with fetal growth restriction, non-reassuring fetal status, and preeclampsia with severe features. Conclusion: Placental perivillous fibrin deposition is clinically significant given risks for fetal growth restriction and preterm delivery for fetal indications. Therefore, when ultrasound findings are suggestive of this pathology, the obstetrician should be prompted to increase surveillance of the given pregnancy.