Massive perivillous fibrinoid causing recurrent placental failure.

Objective: To establish the incidence, recurrence rate and consequences of massive perivillous fibrinoid.
Design: Retrospective analysis of the histology of all placentas with a diagnosis of massive perivillous fibrinoid between 1991 and 1998, together with the maternal case records.
Setting: The histopathology department of the Rotunda Hospital, Dublin, Ireland.
Population: A relatively homogeneous group of pregnant women in the northern part of Dublin City, which is the catchment area for the Rotunda Hospital, delivered between 1991 and 1998.
Methods: Retrospective review of archival placental pathology and maternal charts.
Main Outcome Measures: The incidence of massive perivillous fibrinoid, perinatal outcome and recurrence rate.
Results: The incidence of massive perivillous fibrinoid was 0.028%, with a recurrence rate of approximately 18%. All the infants suffered intrauterine growth restriction; there was a 31% fetal loss rate and a 33% preterm delivery rate.
Conclusions: Massive perivillous fibrinoid is associated with intrauterine death, intrauterine growth restriction and preterm delivery. It has a significant recurrence rate and both the clinical findings of intrauterine growth restriction and the postmortem findings imply a syndrome of chronic placental insufficiency.