Re: placental floor infarction
From: art fougner, md (evsono@pipeline.com)
Mon Jan 4 07:17:58 1999
Careful! someone may want to know the evidence for your management ;)
seriously, good job!
Art
At Mon, 04 Jan 1999, Isabelle Wilkins wrote:
>
>Luis
>
>I recently delivered someone with this diagnosis (maternal placental floor
>infarction). She had 4 or 5 previous first trimester losses and 2 previous
>second trimester losses. We pulled path and came up with that dx. There is
>some suggestion in the path literature based on its presumed mechanism that
>it may be similar in etiology to anti-phospholipid syndrome, albeit with
>normal labs. So, we treated with asa and heparin. She had a first trimester
>loss on asa before we could start heparin, but with our second attempt
>delivered 1 month ago at 34 weeks a slightly IUGR, vigorous baby. Too soon
>to say that it will not develop a problem like yours did down the road, but
>my reading did not suggest anything like that in other reported cases. One
>interesting thing about my pt was that she required a lot of heparin. She
>was very thin, but had very little bruising with her injections. At 12- 14
>weeks I checked a PTT on 10,000 units a day, and got a value of 22secs. So,
>I empirically upped her dose to keep her at about 40. Her placenta looked
>ratty on US throughout, and she had an elevated MSAFP, but the kid looked
>good up until the end.
>
>--
>Isabelle Wilkins
>MFM
>Baylor College of Medicine
>
>Date: Tue, 29 Dec 1998 23:02:37 -0600 (CST)
>From: sanchez-ramos@worldnet.att.net (Luis Sanchez-Ramos)
>To: OB-GYN-L@OBGYN.net
>Subject: Maternal floor infarction of the placenta
>Message-ID: <199812300502.XAA31368@talk.obgyn.net>
>
>On a more serious note:
>
>I am currently caring for a patient with a history of maternal floor
>infarction (this entity is not due to ischemic necrosis). In her
>previous pregnancy she delivered by emergency cesarean, a growth
>restricted infant with severe birth asphyxia. At 8 months of age the
>child suddenly deteriorated and died. He was diagnosed as having an
>inborn error of fatty oxidation (confirmed).
>Does anyone know of any possible connection of maternal floor infarction
>and the fatty oxidation disorder ? Are there any suggestions for the
>prevention of maternal floor infarcts (it is known to recur) ?
>
>--
>Luis Sanchez-Ramos, M.D.
>
>----
>
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
